Localized small cell lung cancer treatment
Patients with small cell lung cancer (even if localized in the chest- stages I, II, and III), are normally not candidates for surgery. The only exceptions to these are the cases in stage I of the disease and without any hilar or mediastinal lymph node involvement nor distant metastases. In these cases, surgery is followed by prophylactic chemotherapy and whole brain radiotherapy, as the brain a frequent site of metastasis for this disease.
Small cell lung cancer is very sensitive to chemotherapy and radiotherapy. The objective response rate, which is the probability that the disease shrinks in size due to the treatment, is about 90%, of which 40-50% are complete responses.
Chemotherapy for small cell lung cancer
Standard therapy is based on a combination chemotherapy treatment of two drugs. These include a platinum salt (cisplatin or carboplatin chosen by the doctor based on the patient’s conditions) and etoposide.
Both drugs are administered intravenously. Cycles are repeated every 3 weeks. On the first day of each cycle, both platinum (cisplatin/carboplatin) and etoposide are administered. Etoposide is then administered for the following 2 days. The patient receives up to a maximum of 4-6 cycles of chemotherapy.
Radiotherapy for small cell lung cancer
Radiotherapy is also started at the same time chemotherapy begins. Radiation is performed on the lung lesion and mediastinal lymph nodes (glands in the space between the 2 lungs), which are often affected by the disease.
Depending on the hospital’s expertise, the disease’s size and patient’s health conditions, radiotherapy can be started concurrently with the first cycle of chemotherapy, after the 2nd cycle or at the end of the 4th cycle (which is referred to as sequential chemo-radiotherapy. Evidence from medical literature suggests that the sooner radiotherapy is initiated, the more effective it can be.
How is the effectiveness of the treatment evaluated?
At the end of chemo-radiotherapy, the patient is reassessed with a full body CT scan with contrast, which evaluates the brain, chest and abdomen. The improvements may not be always observable at this stage, as not enough time has passed since the end of radiotherapy and thus, signs of inflammation may still be present in the concerned areas. It is not always easy to distinguish between what is left of the disease and what is actually inflammation on the CT scan. The main objective of this first CT scan (performed at the end of treatment) is to exclude the appearance of new lesions.
If no new lesions are present, upon completion of the therapeutic course, the patient undergoes a preventive whole brain radiotherapy, with the purpose of reducing the possibility of a brain metastasis.
Once the therapies are completed, the patient enters a follow-up phase, consisting of a full body CT scan with contrast every 3 months.