Treatment of Small Cell Lung Cancer Diagnosis and Management of Lung Cancer , 3 rd ed : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Treatment of Small Cell Lung Cancer prehensive chemistry panel with renal and hepatic function tests, CT of the chest and abdomen with intravenous contrast or CT scan of the chest extending through the liver and adrenal glands, MRI or CT of the brain, and bone scan (Grade 1B) . Background: Small cell lung cancer (SCLC) is a lethal disease for which there have been only small advances in diagnosis and treatment in the past decade. Our goal was to revise the evidence-based guidelines on staging and best available treatment options. Methods: A comprehensive literature search covering 2004 to 2011 was conducted in MEDLINE, Embase, and fi ve Cochrane databases using SCLC terms. This was cross-checked with the authors’ own literature searches and knowledge of the literature. Results were limited to research in humans and articles written in English. Results: The staging classifi cation should include both the old Veterans Administration staging classifi cation of limited stage (LS) and extensive stage (ES), as well as the new seventh edition American Joint Committee on Cancer/International Union Against Cancer staging by TNM. The use of PET scanning is likely to improve the accuracy of staging. Surgery is indicated for carefully selected stage I SCLC. LS disease should be treated with concurrent chemoradiotherapy in patients with good performance status. Thoracic radiotherapy should be administered early in the course of treatment, preferably beginning with cycle 1 or 2 of chemotherapy. Chemotherapy should consist of four cycles of a platinum agent and etoposide. ES disease should be treated primarily with chemotherapy consisting of a platinum agent plus etoposide or irinotecan. Prophylactic cranial irradiation prolongs survival in those individuals with both LS and ES disease who achieve a complete or partial response to initial therapy. To date, no molecularly targeted therapy agent has demonstrated proven effi cacy against SCLC. Conclusion: Evidence-based guidelines are provided for the staging and treatment of SCLC. LS-SCLC is treated with curative intent with 20% to 25% 5-year survival. ES-SCLC is initially responsive to standard treatment, but almost always relapses, with virtually no patients surviving for 5 years. Targeted therapies have no proven effi cacy against SCLC . CHEST 2013; 143(5)(Suppl):e400S–e419S