Patients with limited disease small cell lung cancer have cancer that is confined to a single location in the chest that is not detectable outside the lung. Patients with this type of cancer are potentially curable, although many patients have undetectable areas of cancer outside of the chest at the time of diagnosis. The median overall survival with limited small cell lung cancer is roughly 20 months.1
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of the treatment of limited small cell lung cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.
Chemotherapy—usually delivered in combination with radiation therapy—is the mainstay of treatment for limited small cell lung cancer. Although the cancer often eventually returns, many small cell lung cancers have a good initial response to treatment with combination chemotherapy. The most commonly used chemotherapy regimen for limited small cell lung cancer involves cisplatin and etoposide. Chemotherapy is a systemic (whole-body) treatment.
Radiation therapy is a local treatment that treats cancer in the chest. It is often delivered at the same time as chemotherapy (concurrent treatment). In other cases, it may be given after completion of chemotherapy (sequential treatment).
Because small cell lung cancer tends to spread quickly, most people with this type of cancer are not candidates for surgery. In a small number of cases, however, the cancer may involve only a single, small area of the lung. In these cases, surgery may be able to remove the cancer. After surgery, patients often receive additional treatment with chemotherapy (or chemotherapy plus radiation therapy) in order to treat undetectable areas of cancer that may remain in the body.
Prophylactic Cranial Irradiation
Small cell lung cancer commonly spreads to the brain. For people without detectable brain metastases at the time of diagnosis, preventive treatment of the brain with radiation therapy can reduce the likelihood of brain metastases and prolong survival. This treatment is called prophylactic cranial irradiation. Prophylactic cranial irradiation is typically reserved for patients who have had a good response to their initial treatment with chemotherapy and radiation therapy.
Strategies to Improve Treatment
While some progress has been made in the treatment of limited small cell lung cancer, better treatment strategies are needed, as many patients still experience disease recurrence. The progress that has been made in the treatment of small cell lung cancer has resulted from development of multi-modality treatments and participation in clinical trials. Future progress in the treatment of small cell lung cancer will result from continued participation in appropriate clinical trials. There are several areas of active exploration aimed at improving the treatment of small cell lung cancer.
Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.
New Combination Chemotherapy Regimens: Clinical trials continue to evaluate new drugs and new combinations of drugs in an effort to improve upon the treatment results achieved with standard chemotherapy regimens.
Targeted Cancer Therapies: Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target,” targeted therapies may slow cancer cell growth or increase cancer cell death. Several different types of targeted therapies are being evaluated for the treatment of small cell lung cancer.
1 Neal JW, Gubens MA, Wakelee HA. Current management of small cell lung cancer. Clin Chest Med. 2011;32:853-863.