70% of patients have extensive disease at time of diagnosis
approximately 75% of patients respond to combination chemotherapy which can induce temporary remission and increase life expectancy
in patients with limited disease, thoracic radiotherapy used in conjunction with chemotherapy can improve survival
the risk of brain metastases can be reduced with the use of prophylactic radiotherapy in patients who respond to chemotherapy
NICE recommend (1):
offer all SCLC patients multidrug platinum-based chemotherapy
if the disease responds, offer four to six cycles of chemotherapy. Maintenance treatment is not recommended
if limited-stage SCLC then offer thoracic irradiation concurrently with the first or second cycle of chemotherapy or after completion of chemotherapy if there has been at least a good partial response within the thorax
if extensive disease then consider thoracic irradiation after chemotherapy if there has been a complete response at distant sites and at least a good partial response within the thorax
prophylactic cranial irradiation should be considered for patients with limited disease and complete or good partial response after primary treatment
for most cases treatment is palliative
radiotherapy may be used to ease pain or bronchial obstruction and pleurodesis may be indicated for recurrent pleural effusions
palliative endoscopic laser therapy of obstructive lesions of large airways may also be effective
if recurrent small cell lung cancer
NICE state that (2):
oral topotecan is recommended as an option only for people with relapsed small-cell lung cancer for whom:
re-treatment with the first-line regimen is not considered appropriate and
the combination of cyclophosphamide, doxorubicin and vincristine (CAV) is contraindicated
intravenous topotecan is not recommended for people with relapsed small-cell lung cancer
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