New approaches for small-cell lung cancer: local treatments.
BACKGROUND
Limited-disease small-cell lung cancer (LD-SCLC) can be cured with combinations of systemic chemotherapy and local treatments, predominantly radiation therapy. While systemic control inside the brain has been further improved with the inclusion of prophylactic cranial irradiation, long-term local control remains suboptimal, even with newer chemoradiation protocols.


METHODS
The authors review the current management of LD-SCLC and discuss strategies to improve local control. They present their own experience with the inclusion of surgery in an aggressive combined-modality protocol for patients with LD-SCLC.


RESULTS
Different approaches to improve local efficacy of treatment have been explored, including concurrent chemoradiation, administration of radiation as early as possible, newer fractionation schemas, and escalation of overall radiation doses. However, even following the currently most active chemoradiation protocols, local and locoregional relapse of LD-SCLC remains a problem. Surgery is feasible within this clinical setting and may add to long-term local control and possible cures.


CONCLUSIONS
Further investigation into the inclusion of surgery in LD-SCLC within carefully designed prospective clinical trials seems justified, although final evaluation would necessarily include prospective, randomized testing within a more "modernized" study design compared to the "old" and "historical" randomized Lung Cancer Study Group trial.
Eberhardt
Wilfried
W
Internal Medicine (Cancer Research), West German Cancer Centre, Medical School of the University of Duisburg-Essen, Germany. wilfried.eberhardt@uni-essen.de
Korfee
Sonke
S
D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors