Carcinoma microcítico de pulmón

Small cell lung cancer accounts for about 15% of all lung neoplasms and is closely related to smoking. It displays singularly aggressive behavior; the five-year survival rate is approximately 5%. Small cell lung cancer should be suspected when a lung mass with voluminous lymph node involvement and extensive metastatic involvement is identified in a patient with a high smoking burden. A biopsy should be performed as soon as possible as well as full staging via thoracic-abdominal-pelvic CT scan and PET-CT in case of limitated-stage disease. Likewise, a cranial CT scan should also be performed given the high brain tropism of this neoplasm.

The treatment of choice in limitated-stage disease is the combination of chemotherapy (cisplatin-based) and radiotherapy administered concurrently. In patients with metastases (extensive disease), the first-line treatment of choice is a combination of chemotherapy (cisplatin or carboplatin and etoposide), together with an immune checkpoint inhibitor (atezolizumab or durvalumab). If progression occurs, administering topotecan or even retreatment with platinum can be considered, although it has low response rates.