title: Small-cell lung cancer.
abstract: The incidence and mortality of small-cell lung cancer worldwide make this disease a notable health-care issue. Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases. Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities. Patients often present with rapid-onset symptoms due to local intrathoracic tumour growth, extrapulmonary distant spread, paraneoplastic syndromes, or a combination of these features. Staging aims ultimately to define disease as metastatic or non-metastatic. Combination chemotherapy, generally platinum-based plus etoposide or irinotecan, is the mainstay first-line treatment for metastatic small-cell lung cancer. For non-metastatic disease, evidence supports early concurrent thoracic radiotherapy. Prophylactic cranial irradiation should be considered for patients with or without metastases whose disease does not progress after induction chemotherapy and radiotherapy. Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain. Signalling pathways have been identified that might yield new drug targets.
authors.affiliation: Department of Respiratory Medicine and Lung Oncological Network, Ghent University Hospital, Ghent, Belgium. jan.vanmeerbeeck@ugent.be
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Meerbeeck
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fennell
authors.forename: Dirk K M
authors.initials: DK
authors.lastname: De Ruysscher
mesh_terms: D000465:Algorithms; D000906:Antibodies / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001921:Brain / Q000528:radiation effects; D001932:Brain Neoplasms / Q000517:prevention & control / Q000556:secondary; D003952:Diagnostic Imaging; D020869:Gene Expression Profiling; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010257:Paraneoplastic Syndromes; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000037:antagonists & inhibitors; D018714:Radiotherapy, Adjuvant; D055752:Small Cell Lung Carcinoma / Q000453:epidemiology / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D016540:Smoking Cessation
chemical_list: D000906:Antibodies; D011518:Proto-Oncogene Proteins