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Review
. 2014 Mar 15;120(6):790-8.
doi: 10.1002/cncr.28505. Epub 2013 Dec 10.

Progress in the management of limited-stage small cell lung cancer

Affiliations
Review

Progress in the management of limited-stage small cell lung cancer

Arya Amini et al. Cancer. .

Abstract

Approximately 15% of lung cancer cases are of the small cell subtype, but this variant is highly aggressive and is often diagnosed at advanced stages. Outcomes after current treatment regimens have been poor, with 5-year survival rates as low as 25% for patients with limited-stage disease. Advances in therapy for small cell lung cancer have included the development of more effective chemotherapeutic agents and radiation techniques. For example, hyperfractionated radiotherapy given early in the course of the disease can reduce local recurrence and extend survival. Other technologic advances in radiation planning and delivery such as intensity-modulated radiotherapy, image-guided adaptive radiotherapy, and 4-dimensional computed tomography/positron emission tomography have facilitated the design of treatment volumes that closely conform to the shape of the tumor, which allows higher radiation doses to be given while minimizing radiation-induced toxicity to adjacent structures. Future improvements in outcomes will require clarifying the molecular basis for this disease.

Keywords: accelerated radiotherapy; chemotherapy; hyperfractionated radiotherapy; lung cancer; radiotherapy; small cell.

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Figures

Figure 1
Figure 1
Progression-free survival rates for early versus late thoracic irradiation with concurrent chemotherapy in the treatment of limited-stage small cell lung cancer, as studied by the National Cancer Institute of Canada Clinical Trials Group (Murray et al. J Clin Oncol 1993). TI, thoracic irradiation.
Figure 2
Figure 2
Kaplan-Meier estimates of overall survival for patients receiving twice-daily versus once-daily thoracic radiotherapy for limited-stage small cell lung cancer in the Intergroup trial 0096 (Turrisi et al., NEJM 1999).
Figure 3
Figure 3
Kaplan-Meier estimates of overall survival for high-dose thoracic radiation given twice daily with concurrent cisplatin-etoposide in the Radiation Therapy Oncology Group (RTOG) trial 0239 (Komaki et al., IJROBP 2012). MST, median survival time; CI, confidence interval.
Figure 4
Figure 4
Treatment schema for Cancer and Leukemia Group B (CALGB) 30610/RTOG 0538, an ongoing phase III trial comparing thoracic radiotherapy regimens for limited-stage small cell lung cancer. CDDP, cisplatin; VP-16, etoposide; PCI, prophylactic cranial irradiation; QD, daily; BID, twice daily.

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