Small cell carcinoma of the lung medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with small cell carcinoma (SCC) of the lung have many treatment options. The selection depends on the stage of the tumor. The options are radiation therapy, chemotherapy, surgery, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Initial Medical Therapy

Limited Stage SCC

 
 
 
 
 
 
 
 
 
 
 
 
Limited stage SCC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Clinical stage T(1-2),N(0)
 
 
 
 
 
 
 
 
 
Limited stage in excess of T(1-2),N(0)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What is the statuses of the pathologic mediastinal staging AND operability of the patient?
 
 
 
 
 
 
 
 
 
What is the performance status of the patient?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Negative pathologic mediastinal staging
AND
Patient is medically operable
 
 
 
 
 
Positive pathologic mediastinal staging
OR
Patient is medically operable
 
Good (PS 0-2)
 
Poor (PS 3-4) due to SCC
 
Poor (PS 3-4) not due to SCC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lobectomy
PLUS
Lymph node dissection or sampling
 
 
 
 
 
What is the performance status of the patient?
 
Chemotherapy
PLUS
Thoracic radiation therapy
 
Chemotherapy
WITH/WITHOUT
Thoracic radiation therapy
 
Individualized treatment
PLUS
supportive care
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What is the status of involvement of the lymph nodes?
 
 
 
Good (PS 0-2)
 
Poor (PS 3-4) due to SCC
 
Poor (PS 3-4) not due to SCC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
N0
 
N+
 
Chemotherapy
PLUS
Thoracic radiation therapy
 
Chemotherapy
WITH/WITHOUT
Thoracic radiation therapy
 
Individualized treatment
PLUS
supportive care
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chemotherapy
 
Chemotherapy
PLUS
Mediastinal radiotherapy
 
 

Extensive Stage

 
 
 
 
 
 
 
 
 
 
Extensive stage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is there symptomatic localized metastasis
OR
brain metastasis?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
Yes, there is symptomatic localized metastasis
 
 
 
 
 
Yes, there is brain metastasis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What is the performance status of the patient?
 
 
 
 
 
What metastasis related symptoms does the patient have?
 
 
 
 
 
Is the patient symptomatic?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Good (PS 0-2)
OR
Poor (3-4) due to SCLC
 
Poor (3-4) not due to SCLC
 
Superior vena cava syndrome
OR
Lobar obstruction
OR
Bone metastasis
 
Spinal cord compression
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Combination chemotherapy
PLUS
Supportive care
 
Individualized therapy
PLUS
Supportive care
 
Chemotherapy
WITH/WITHOUT
Radiation therapy to the sites of metastasis
 
Radiation therapy to the sites of metastasis
THEN
Chemotherapy (unless medical therapy is immediately necessary)
 
Whole brain radiation therapy
THEN
Chemotherapy (unless medical therapy is immediately necessary)
 
Chemotherapy
THEN
Whole brain radiation therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the patient at elevated risk for fracture?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Palliative external beam radiation therapy
PLUS
Orthopedic stabilization
 
No additional measures
 
 
 
 
 
 
 
 
 

Adjuvant Medical Therapy

Therapy for Relapse or Palliative Therapy

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