Radiation Therapy in Extensive Disease Small Cell Lung Cancer

Abstract

Approximately two-thirds of all patients with small-cell lung cancer have the disease that spread beyond confines of the thorax, including as well patients whose disease has traditionally been described as "too large to be encompassed with a tolerable radiation port". For these patients, chemotherapy has been considered standard treatment option for many decades. However, patterns of failure after chemotherapy alone in this disease reveals substantial percentage of patients failing in the chest. It is, therefore, that curative, high-dose thoracic radiation therapy could offer improvement in chest disease control and, hence, improved survival. However, in spite of these observations, thoracic radiation therapy has mostly been used in palliative setting. In a landmark trial, Jeremic et al have shown that in a suitable patients, those with best prognosis, radical chest radiation therapy can indeed offer an improvement in local control and overall survival over that obtained with the same chemotherapy given alone. This was achieved at the expense of low toxicity. recent single-institutional studies from Canada and China seem to confirm this, while two ongoing prospective studies should help further refine radiation therapy approach in this disease.