Combined Modality Treatment of Limited Stage Small Cell Carcinoma of the Lung

Small cell lung carcinoma comprises approximately 10-20% of all lung cancers. At the time of diagnosis, 20-30% of patients have what is considered limited stage disease. Historically, chemotherapy has been the mainstay of treatment for small cell lung cancer, but more recent evidence from large meta-analyses have established the local control and overall survival advantages conferred by the addition of external beam thoracic radiotherapy in combination with chemotherapy for limited stage disease along with prophylactic cranial irradiation for complete responders. At present, radiotherapy is recommended to commence in concurrentoe with an earlier cycle of chemotherapy. Despite the established role of thoracic radiotherapy combined with chemotherapy for patients with limited stage disease, the optimal radiotherapy dose-fractionation schedule is still undefined. Recent investigational radiotherapy approaches applied to limited stage small cell lung cancer patients include hyperfractionated radiotherapy, dose-escalated daily radiotherapy, and hypofractionation. While several chemotherapy regimens and targeted systemic agents have been investigated in small numbers of small cell lung cancer patients, cisplatin with etoposide remains the current standard chemotherapy regimen for this cancer.