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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
Spiro S. G. 1, Hackshaw A. K. 2
1 University College London Hospitals, London, UK
2 Cancer research UK and University College London Cancer Trials Centre, London, UK
The treatment of this cell type of lung cancer remains difficult and improvements are elusive. About 20% of all new cases present as this cell type, and although extremely sensitive to combination chemotherapy, there have been few noteworthy advances in the last 10 years, and this has been reflected in a decreasing interest into research of this cell type, despite its apparent responsiveness to treatment. Most small-cell lung cancer respond well and promptly to radiotherapy which remains an excellent palliative modality for metastatic disease. However, the place of radiotherapy as a radical treatment, together with chemotherapy, has remained controversial. Meta-analyses have shown it to confer a small improvement (around 5%) to the use of chemotherapy alone to the 3 year survival rate, but whether to give this before, after or concurrent with chemotherapy has been a difficult choice. And moreover, do fractionation patterns matter? This review looks at the studies which have addressed this question in order to understand how and when radiotherapy should be given and in what dose. Although reports suggest that early treatment is advantageous, and that hyperfractionation protocols may be better, the most important treatment seems the full administration of the intended chemotherapy regimen.