21 - Small cell lung cancer

Summary

Introduction

Small cell lung cancer (SCLC) accounts for 20–25% of all newly diagnosed patients with lung cancer. Up to the early 1970s surgery and/or radiation therapy were the most frequent forms of treatment used. However, it was rapidly recognized that, even with such therapies, the majority of patients developed widespread disseminated disease in a short period with most patients dying within 3 months of diagnosis. More detailed staging procedures coupled with autopsy studies of patients who died within 28 days of ‘curative surgical resection’ for small cell lung cancer led to our current understanding of the biological behaviour of this tumour. With few exceptions all patients will have metastatic disease at diagnosis (clinically evident or not) and that treatment aimed solely at the primary tumour (radiotherapy or surgery) is purely palliative in nature for almost all patients and has little impact upon overall survival.

It soon became recognized that SCLC (unlike all other forms of lung cancer) demonstrates unique sensitivity to many different chemotherapeutic agents and radiation therapy. In subsequent trials carried out over the past two decades, the central role of combination chemotherapy in the treatment of all patients with small cell lung cancer, irrespective of their disease extent, has emerged. With combination chemotherapy and with the use in selective cases of chest radiotherapy and/or prophylactic cranial radiation therapy, responses to treatment will be observed in 80–90% of patients including complete remissions in 30–40%.