Radiation and Systemic Therapy for Limited-Stage Small-Cell Lung Cancer

Abstract

Progress in the overall treatment of small-cell lung cancer (SCLC) has moved at a slower pace than non–small-cell lung cancer. In fact, the standard treatment regimen for limited stage SCLC has not appreciably shifted in more than 20 years, consisting of four to six cycles of cisplatin and etoposide chemotherapy concurrent with thoracic radiotherapy (TRT) followed by prophylactic cranial irradiation (PCI) for responsive disease. Nevertheless, long-term outcomes have improved with median survival approaching 25-30 months, and approximately one third of patients now survive 5 years. This is likely attributable in part to improvements in staging, including use of brain magnetic resonance imaging and fluorodeoxyglucose–positron emission tomography imaging, advances in radiation treatment planning, and supportive care. The CONVERT and CALGB 30610 phase III trials failed to demonstrate a survival advantage for high-dose, once-daily TRT compared with standard 45 Gy twice-daily TRT, although high-dose, once-daily TRT remains common in practice. A phase III comparison of high-dose 60 Gy twice-daily TRT versus 45 Gy twice-daily TRT aims to confirm the provocative outcomes reported with 60 Gy twice daily in the phase II setting. Efforts over time have shifted from intensifying PCI, to attempting to reduce treatment-related neurotoxicity, to more recently questioning whether careful magnetic resonance imaging surveillance may obviate the routine need for PCI. The addition of immunotherapy has resulted in mixed success in extensive-stage SCLC with modest benefit observed with programmed death-ligand 1 inhibitors, and several ongoing trials assess programmed death-ligand 1 inhibition concurrent or adjuvant to chemoradiotherapy in limited-stage SCLC. Major advances in future treatment will likely depend on a better understanding and exploiting of molecular characteristics of SCLC with increasing personalization of therapy.

DNA Hydroxymethylation in Smoking-Associated Cancers

“…In addition, 5-hmC has shown promise as a good indicator of lung tumor stage, which is important considering that different stages of lung cancer require different therapies [ 173 ]. For example, early stage non-small-cell lung cancer (NSCLC) is treated surgically, whereas patients with locally advanced disease (stage III) require multimodal therapy [ 174 , 175 ]. Personalized treatment based on the patient’s tumor stage and clinical conditions has shown to improve the overall survival in lung cancer cases [ 176 , 177 ].…”

Exosomes in Liquid Biopsy: A Nanotool for Postradiotherapy Cancer Monitoring

“…Radiotherapy is one of the major therapies for many types of tumors [1][2][3]. Although radiotherapy can locally control tumors and improve the quality of life of patients [4], some problems often occur after radiotherapy.…”

“…On this basis, we summarize the application and potential of exosomes in liquid biopsy after tumor radiotherapy. Altered exosomal cargo after tumor radiotherapy is used (1) as an indicator of tumor radiotherapy and can be used for the continuous assessment of radiotherapy efficacy through dynamic monitoring; (2) to predict and detect tumor recurrence, overall survival, early progression, and metastasis, as well as to suggest cognitive impairment after radiotherapy; and (3) to help optimize treatment planning (guide tumor patients' medications during radiotherapy, reduce radiotherapy resistance through targeted therapy, and perform a risk assessment to select treatment options). This review provides an innovative direction for liquid biopsy after tumor radiotherapy and for the monitoring of oncology radiotherapy.…”

External Application of a Nomogram to Predict Survival and Benefit of Peripheral Blood Inflammatory Indexes in Limited-Stage Small Cell Lung Cancer

“…Small cell lung cancer (SCLC), accounting for approximately 15% of all lung cancer, has a poor prognosis because of its very aggressive clinical course and early metastasis. Limited stage small cell lung cancer (LS-SCLC) makes up almost 40%, with a median overall survival (OS) of 20 months ( 3 , 4 ). The early accurate prediction of patients’ prognoses is significant for making the most favorable treatment decisions.…”

“…The early accurate prediction of patients’ prognoses is significant for making the most favorable treatment decisions. At present, the standard treatment for LS-SCLC is the combination of chemotherapy, thoracic radiotherapy, and prophylactic cranial irradiation (PCI) ( 3 ). Although immunotherapy has become the new standard of first-line treatment for extensive-stage SCLC (ES-SCLC), the additional benefit for LS-SCLC is not clear ( 3 – 5 ).…”