J.Jpn. Surg. Soc.. 98(1): 46-52, 1997

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Feature topic

THERAPEUTIC STRATEGY FOR SMALL CELL LUNG CANCER

Recent progress in the treatment of small cell lung cancer (SCLC) is described in this review article. Many anti-cancer agents have appeared to be active against SCLC. Cyclophosphamide, Adriamycin and vincristine (CAV), cyclophosphamide, Adriamycin and etoposide (CAE), CAV plus etoposide (CAVE), and cisplatin and etoposide (PE) are widely used as the first line chemotherapy. CAV alternating with PE have been considered to be one of the standard regimens in the treatment of SCLC. Dose intesive weekly chemotherapies have suggested to have high response rate and prolong survival in non-randomized trials. However, recent randomized trials have not shown that weekly chemotherapy is superior to 3-weekly chemotherapy. A meta-analysis appears that combined modality of chemotherapy and thoracic radiotherapy (TRT) is superior to chemotherapy alone in the treatment of limited disease (LD) SCLC. Recent clinical trials have demonstrated that concurrent use of PE chemotherapy and twice daily TRT provide survival benefit in the patients with LD-SCLC. Many randomized trials have shown that prophylactic cranial irradiation reduces the incidence of CNS metastases, however, do not prolong the survival of patients with SCLC. Further investigations of new drug and new modality in the treatment of SCLC are warranted.

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