Lung Cancer

Question 1

General Considerations in Treatment of SCLC

Answer 1

1) Sensitive to radiation and chemotherapy
2) Systemic disease at diagnosis
3) Limited role for surgery
4) Overall 5 year survival is 5%

Question 2

Goal of Therapy in Limited Stage Chemotherapy

Answer 2

Goal: Curative intent

1) 40% alive at 2 years
2) Median survival 16-22 months

Question 3

Treatment of limited stage SCLC

Answer 3

1) Surgery limited to patients with small, single nodule (<5% of patients
2) Combined modality therapy: Concurrent chemoradiotherapy
a) Regimen contains etoposide and cisplatin and radiation
b) carboplatin can be substituted for cisplatin but limited studies
c) usually 4-6 cycles, no maintenance
d) myeloid growth factors should not be used during chemoradiation
e) Response rates: 65-95% overall response rate (ORR), 45-75% complete remission (CR)

Question 4

Goal of Therapy in Extensive Stage SCLC

Answer 4

1) Survival without treatment: about 5 weeks
2) Median survival with treatment: 9-11 months
3) 2 year survival: Less than 5%

Question 5

Treatment of Extensive Stage SCLC

Answer 5

1) Combination Therapy
a) Cispatin- or Comboplatin-based regimen plus etoposide
b) Cisplatin can aslo be combined with irinotecan
c) Response rates: 60-80% ORR, 15-20% CR
2) Paliative radiation - does not improve results
3) Cranial radiatoin
a) with brain mets - whole brain radiation before (symptomatic) or after (asymptomatic) chemo
b) no brain mets - prophylactic cranial radiation given to patients attaining a response in the chest
c) increases 1-year survival from 13-27%
4) no role for maintenance therapy