Standard treatment of small-cell lung cancer involves combination chemotherapy with a cisplatin-containing regimen. Treatment cycles are typically repeated every three weeks. People receive treatment for four to six cycles.
Radiotherapy to the chest may be started as early as possible, or it may be given later in the course of treatment. This depends on factors such as the stage of the cancer and the person’s overall health.
Radiation and chemotherapy: Sequential-radiation treatment may be given, followed by chemotherapy. However, in comparative studies, the earlier the radiation is started concurrently with chemotherapy (as early as the first cycle of chemotherapy), the better the outcome.
If the patient has limited disease, and has had a very good response to chemotherapy, radiation therapy may be given to the patient’s brain to reduce the risk of small-cell lung cancer spreading to the brain. This is called prophylactic cranial irradiation (PCI). It is usually given after the patient has completed the full chemotherapy, and radiotherapy (to the thorax). The radiation doses are low, and the treatment duration is short, so the side effects of this therapy are minimal.
Treatment of extensive-stage small-cell lung cancer (small-cell lung cancer that remains incurable with current treatment options)
Persons with extensive-stage small-cell lung cancer are treated with combination chemotherapy. Currently, the combination of cisplatin or carboplatin and etoposide (PE) is the most widely used regimen.
Radiation therapy may be used for relief of the following symptoms:
Compression of the food pipe (esophagus), windpipe, spinal cord, or superior vena cava caused by tumors
Persons who have a relapse of small-cell lung cancer have an extremely poor prognosis.
If the disease does not respond to treatment or progresses after initial treatment (called "refractory disease") additional treatment may help relieve symptoms and increase survival time somewhat. The most common drug used in this setting is topotecan.
Persons whose cancer does not progress for more than three months may be given additional chemotherapy, including re-treatment with their original chemotherapy regimen.