Treatment of SCLC

Treatment of SCLC

Although SCLC is highly responsive to both systemic chemotherapy and radiotherapy, it commonly relapses within months despite treatment. Therapy with multiple chemotherapeutic drugs in conjunction with thoracic radiation prolongs survival. Still, only 15-20% of limited stage patients will survive, and none in extensive stage.

Cytotoxic chemotherapy based on platinum combination regimens has resulted in significant improvement in survival, particularly for patients with limited stage of the disease. The combination of cisplatin or carboplatin plus etoposide (PE) gives the best results. Carboplatin is frequently substituted for cisplatin because of its more favourable toxicity profile. However, two-drug regimens substituting a topoisomerase inhibitor (irinotecan, irinotecan, or epirubicin) for etoposide are reasonable alternatives. Other chemotherapeutic agents with significant activity against SCLC include the alkylating

agents ifosfamideand cyclophosphamide, doxorubicin, the taxanes paclitaxel and docetaxel, and vincristine. The combination cyclophosphamide, doxorubicin and etoposide (CDE) was very popular in the past, but the toxicity was higher than the more recent agents which show at least the same efficacy.

Patients with limited disease SCLC receive thoracic irradiation concurrent with chemotherapy. Prophylactic cranial irradiation is performed after chemotherapy in patients with limited stage disease, as well as good responders with extensive stage SCLC.

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