ABSTRACT
During the past three decades, treatment progress in small cell lung cancer (SCLC) has been modest and mainly achieved in patients staged as having limited disease (LD-SCLC) by the addition and refining of locoregional radiation to systemic chemotherapy. Three landmarks have been accomplished: (1) the addition of thoracic radiation therapy to systemic chemotherapy; (2) the demonstration of the superiority of early and/or twice-daily radiation therapy compared with late, once-daily fractionation; and ( 3 ) prophylactic radiation therapy of the brain, the so-called prophylactic cranial irradiation (PCI). Each of these innovations has contributed to an improvement of the 5-year survival rate in LD-SCLC. In contrast, progress in the treatment of patients with extensive disease (ED-SCLC) has been very modest. However, recently a significant step towards further improvement of palliative treatment has emerged with the demonstration that PCI also plays a definite role in the treatment of extensive disease. 1
Since the publication of Lung Cancer Therapy Annual 5, the historical background and current treatment of SCLC have been subjected to several reviews. 2-6 Moreover, updated clinical guidelines have been published by the National Comprehensive Cancer Network (NCCN), 7 the American College of Chest Physicians (ACCP), 8 the European Society for Medical Oncology (ESMO), 9 and the National Cancer Institute (NCI). 10
Certain areas of clinical research have been of particular interest. The optimal way to deliver chest radiotherapy remains unresolved; the definition of target volume, dose, fractionation, and timing of thoracic radiation is a matter of continuous debate and subject of several clinical studies. As for the development of new chemotherapeutic strategies, the results of clinical studies aimed at introducing the DNA topoisomerase I targeting drugs, e.g. topotecan and irinotecan, are emerging and, thus, yield new insights into the expansion of the treatment armentarium. As opposed to non-small cell lung cancer (NSCLC), the introduction of targeted therapies, such as mono-and polytargeted kinase inhibitors as well as immunotherapy has not yet led to significant, positive clinical outcomes.
