Limited stage small cell lung cancer: treatment and therapy.

Chemotherapy remains the key treatment for small cell lung cancer; today, that chemotherapy remains cisplatin and etoposide in a variety of acceptable schedules. Attempts to use new drugs in extensive disease have not been as successful as hoped; however, a recent trial from Japan supports the use of irinotecan and cisplatin over the standard cisplatin and etoposide, but these facts need to be verified in western countries. For limited disease, the addition of thoracic radiotherapy for all patients and prophylactic cranial irradiation (PCI) in complete, or near complete, responders have resulted in improved survival. The best results occur with early, intensive thoracic radiotherapy concurrent with chemotherapy and PCI after completion of systemic and local therapy. The use of PCI and thoracic radiotherapy in extensive disease is more controversial and less evidence based. PCI and thoracic radiotherapy may be considered only in patients who have achieved a "systemic" complete response and excellent response in the chest. However, both prospects should be supported if there is complete response systemically and near complete response locally. The role of surgery is of limited value in the unusual cases of mediastinal negative disease, but it is a good treatment for patients with peripheral nodules and sufficient pulmonary function to withstand thoracotomy.