Extensive stage small cell lung cancer.

Small cell lung cancer is a rapidly proliferating, biologically aggressive form of lung cancer that has a short survival without treatment. Chemotherapy is the foundation of the therapeutic approach to patients with small cell lung cancer. Most patients present with extensive disease, and, although few patients are cured, significant improvement in survival is possible with modern chemotherapy. The role of radiation therapy in extensive disease is palliative, and surgery has little role in patient management. The standard chemotherapy regimen for patients with small cell lung cancer has become either cisplatin or carboplatin with etoposide. Second-line chemotherapy regimens are moderately effective in patients previously responding to initial chemotherapy. Newer chemotherapy agents show promise, but few randomized trials have been completed in extensive disease. Physicians should be encouraged to include their patients with extensive small cell lung cancer in the evolving clinical trials.