Radiochemotherapy in extensive disease small cell lung cancer ED-SCLC.

Abstract

Patients with extensive disease small cell lung cancer (ED-SCLC) represent approximately one-third of all SCLC patients. For these patients, chemotherapy (CHT) is the standard treatment of choice. With CHT given alone, however, there is not a high risk of distant progression, but also progression within the thorax and brain frequently occurs, even in patients achieving a response to CHT. To improve poor figures obtained with CHT alone and address important issue of intrathoracic tumor control and it relationship to overall survival, thoracic radiation therapy (TRT) was introduced with a curative intent in a prospective randomized trial by Jeremic et al (1988-1993). In that trial CHT alone was compared with CHT followed by TRT, and in both groups by a prophylactic cranial irradiation. This trial showed that TRT can offer an improvement on local control that leads to an improvement in overall survival. Toxicity was acceptable, while multivariate analysis identified number of metastasis as an independent prognosticator of outcome. Based on the data of this trial, researchers in the USA and Europe will undergo two prospective trials addressing the issue of TRT in ED-SCLC.