Small cell carcinoma of the lung

Small cell lung cancer is a common neoplasm with unique biological and clinical features. It is more sensitive to both chemotherapy and radiation therapy than the other types of lung cancer which are collectively referred to as the "nonsmall cell lung cancers". By the late 1960s, it had become evident that local modalities of therapy, such as irradiation and surgical resection, were incapable of affecting long-term survival due to the proclivity of this neoplasm for early, widespread dissemination. Consequently, over the past 15 years, combination chemotherapy has become the cornerstone of management. However, the majority of patients with small cell lung cancer continue to die of their disease; thus, studies designed to improve treatment results and understand the basic biology of this cancer continue. Recently evaluated treatment strategies have included the use of "noncross resistant" chemotherapy, dose intensification, combined modality treatment employing locoregional irradiation in conjunction with chemotherapy, and "adjuvant" surgery. Several groups have also attempted to determine the optimum duration of chemotherapy, while others have focused on developing effective salvage therapy. Other investigators have concentrated on better understanding the basic biology of small cell lung cancers in an effort to develop potentially new therapeutic strategies to be used alone or in conjunction with current treatment modalities. Finally, our ability to prognosticate for small cell lung cancer is rather crude and efforts are underway to improve staging techniques. This article will review many of the studies of the past 5 years which have dealt with these issues.