Related Summaries
Statistics
Limited-Stage Disease
Extensive-Stage Disease
Prognostic Factors

Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)

Other PDQ summaries containing information related to lung cancer include:

• Non-Small Cell Lung Cancer Treatment.
• Lung Cancer Prevention.
• Lung Cancer Screening.

Estimated new cases and deaths from lung cancer (small cell lung cancer and non-small cell lung cancer combined) in the United States in 2008:[1]

• New cases: 215,020.
• Deaths: 161,840.

Small cell lung cancer (SCLC) accounts for approximately 15% of bronchogenic carcinomas. The overall incidence and mortality rates of SCLC in the United States have decreased during the past few decades.[2] Without treatment, SCLC has the most aggressive clinical course of any type of pulmonary tumor, with median survival from diagnosis of only 2 to 4 months. Compared with other cell types of lung cancer, SCLC is more responsive to chemotherapy and radiation therapy; however, a cure is difficult to achieve because SCLC has a greater tendency to be widely disseminated by the time of diagnosis. It is the cancer most commonly associated with paraneoplastic syndromes, including the syndrome of inappropriate antidiuretic hormone secretion, paraneoplastic cerebellar degeneration, and Lambert-Eaton myasthenic syndrome.[2]

At the time of diagnosis, approximately 30% of patients with SCLC will have tumors confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. These patients are designated as having limited-stage disease (LD), and most 2-year disease-free survivors come from this group. For patients with LD, median survival of 16 to 24 months and 5-year survivals of 14% with current forms of treatment have been reported.[3-6] Patients diagnosed with LD who smoke should be encouraged to stop smoking before undergoing combined-modality therapy because continued smoking may compromise cure rates.[7]

Improved long-term survival has been shown with combined modality therapy.[6,8][Level of evidence: 1iiA] Although long-term survivors have been reported among patients who received either surgery or chemotherapy alone, chemotherapy combined with thoracic radiation therapy (TRT) is considered the standard of care.[9] Adding TRT increases absolute survival by approximately 5% over chemotherapy alone.[8,10] The optimal timing of TRT relative to chemotherapy has been evaluated in multiple trials and meta-analyses with the weight of evidence suggesting a small benefit to early TRT.[4,11,12][Level of evidence: 1iiA] Prophylactic cranial radiation prevents central nervous system (CNS) recurrence and can improve survival in patients who have had a complete response to chemoradiation.[13,14][Level of evidence: 1iiA]

Patients with tumors that have spread beyond the supraclavicular areas are said to have extensive-stage disease (ED) and have a worse prognosis than patients with LD. Median survival of 6 to 12 months is reported with currently available therapy, but long-term disease-free survival is rare.

The pretreatment prognostic factors that consistently predict for prolonged survival include good performance status, female gender, and LD.[15-19] Patients with involvement of the CNS or liver at the time of diagnosis have a significantly worse outcome.[15-18] A number of biochemical factors including serum sodium, alkaline phosphatase, and lactate dehydrogenase have also been found to independently correlate with outcome.[16,20]

Regardless of stage, the current prognosis for patients with SCLC is unsatisfactory despite improvements in diagnosis and therapy made during the past 25 years. All patients with this type of cancer may appropriately be considered for inclusion in clinical trials at the time of diagnosis. Information about ongoing clinical trials is available from the NCI Web site.

References

1. American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. Last accessed October 1, 2008. 
   
   
2. Govindan R, Page N, Morgensztern D, et al.: Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol 24 (28): 4539-44, 2006.  [PUBMED Abstract]
   
   
3. Fry WA, Menck HR, Winchester DP: The National Cancer Data Base report on lung cancer. Cancer 77 (9): 1947-55, 1996.  [PUBMED Abstract]
   
   
4. Murray N, Coy P, Pater JL, et al.: Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 11 (2): 336-44, 1993.  [PUBMED Abstract]
   
   
5. Turrisi AT 3rd, Kim K, Blum R, et al.: Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340 (4): 265-71, 1999.  [PUBMED Abstract]
   
   
6. Jänne PA, Freidlin B, Saxman S, et al.: Twenty-five years of clinical research for patients with limited-stage small cell lung carcinoma in North America. Cancer 95 (7): 1528-38, 2002.  [PUBMED Abstract]
   
   
7. Videtic GM, Stitt LW, Dar AR, et al.: Continued cigarette smoking by patients receiving concurrent chemoradiotherapy for limited-stage small-cell lung cancer is associated with decreased survival. J Clin Oncol 21 (8): 1544-9, 2003.  [PUBMED Abstract]
   
   
8. Pignon JP, Arriagada R, Ihde DC, et al.: A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 327 (23): 1618-24, 1992.  [PUBMED Abstract]
   
   
9. Chandra V, Allen MS, Nichols FC 3rd, et al.: The role of pulmonary resection in small cell lung cancer. Mayo Clin Proc 81 (5): 619-24, 2006.  [PUBMED Abstract]
   
   
10. Warde P, Payne D: Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 10 (6): 890-5, 1992.  [PUBMED Abstract]
    
    
11. Perry MC, Eaton WL, Propert KJ, et al.: Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med 316 (15): 912-8, 1987.  [PUBMED Abstract]
    
    
12. Takada M, Fukuoka M, Kawahara M, et al.: Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 20 (14): 3054-60, 2002.  [PUBMED Abstract]
    
    
13. Aupérin A, Arriagada R, Pignon JP, et al.: Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 341 (7): 476-84, 1999.  [PUBMED Abstract]
    
    
14. Slotman B, Faivre-Finn C, Kramer G, et al.: Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 357 (7): 664-72, 2007.  [PUBMED Abstract]
    
    
15. Wolf M, Holle R, Hans K, et al.: Analysis of prognostic factors in 766 patients with small cell lung cancer (SCLC): the role of sex as a predictor for survival. Br J Cancer 63 (6): 986-92, 1991.  [PUBMED Abstract]
    
    
16. Rawson NS, Peto J: An overview of prognostic factors in small cell lung cancer. A report from the Subcommittee for the Management of Lung Cancer of the United Kingdom Coordinating Committee on Cancer Research. Br J Cancer 61 (4): 597-604, 1990.  [PUBMED Abstract]
    
    
17. Paesmans M, Sculier JP, Lecomte J, et al.: Prognostic factors for patients with small cell lung carcinoma: analysis of a series of 763 patients included in 4 consecutive prospective trials with a minimum follow-up of 5 years. Cancer 89 (3): 523-33, 2000.  [PUBMED Abstract]
    
    
18. Albain KS, Crowley JJ, LeBlanc M, et al.: Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol 9 (9): 1618-26, 1991.  [PUBMED Abstract]
    
    
19. Singh S, Parulekar W, Murray N, et al.: Influence of sex on toxicity and treatment outcome in small-cell lung cancer. J Clin Oncol 23 (4): 850-6, 2005.  [PUBMED Abstract]
    
    
20. Cerny T, Blair V, Anderson H, et al.: Pretreatment prognostic factors and scoring system in 407 small-cell lung cancer patients. Int J Cancer 39 (2): 146-9, 1987.  [PUBMED Abstract]
    
    

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