Treatment of Extensive Small Cell Lung Cancer
When small cell lung cancer has spread to both lungs or is detectable beyond the lungs, it is referred to as "extensive."
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 a 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 extensive 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 website 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 to learn about new treatments and the results of clinical trials.
Because the cancer has spread outside the chest, it cannot be treated with radiation or removed surgically. Small cell lung cancer is very responsive to chemotherapy and the current standard treatment of extensive disease is chemotherapy. The standard treatment for extensive small cell lung cancer has consisted of combination chemotherapy, mainly with Platinol® (cisplatin) or Paraplatin® (carboplatin) and etoposide. However, more recent research has indicated that combinations including Camptosar® (irinotecan) may be more effective.
Prophylactic Cranial Irradiation (PCI)
PCI is the application of radiation therapy to the head to reduce the risk that cancer will spread to the brain. The role of PCI in the treatment of SCLC has been the subject of several studies. In patients with limited stage SCLC, PCI is recommended for patients who achieve a complete response (remission) with concomitant chemoradiation.
This provides an approximate 5 percent improvement in the 5-year survival rate. The main concern with the use of PCI is the potential for long-term complications such as neurocognitive impairment (for example, memory loss). A study conducted by the European Organization for Research and Treatment of Cancer has suggested a role for PCI even in patients with extensive stage SCLC (Slotman et al, ASCO 2007). This study used randomly selected patients with extensive stage disease following response to chemotherapy (any favorable response), to PCI, or observation.
The study noted a decrease in the incidence of cancer spread to the brain (15 percent versus 40 percent at 1 year) and an improvement in the overall survival rate (27 percent versus 13 percent at 1 year) with PCI. Headache, nausea, and emesis were the common side effects noted with PCI, though a majority of them were mild in severity. Despite certain limitations of the study, such as the performance of imaging studies only for symptoms rather than periodic evaluation, PCI has now become a part of the treatment of extensive stage SCLC.
Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.
This content was last reviewed
August 15, 2010 by Dr. Reshma L. Mahtani.