SCLC is one of the most aggressive pulmonary diseases. Surgery of this tumor type is not feasible because of its tendency to metastasize very early in its developement, and that suggests a systemic disease from the beginning.
The small cell (SCLC) is very sensitive to chemotherapy and radiotherapy (because of the cell being highly kinetic) and therefore usually responds brilliantly to the first line therapy.
Usually, when you get a complete response (ie, a disappearance of the visible disease) it will be carried out a prophylactic radiotherapy on the brain and consolidation on the lung area.
The real problem linked to this disease is its strong tendency to recur (even after a complete radiological response, ie when malignancies are no longer visible after treatment of the masses).
This is because residual tumor cells resistant to treatment can survive and these residual cells tend to grow back.
It is possible to run new second-line treatments, with a lesser effectiveness and continue with different lines of treatment, until the therapeutic effect is marginal, and the balance between risks and benefits becomes unfavourable for the patient.
Standard front line treatment includes a combination of cisplatin and etoposide (with a schedule of three consecutive days of treatment repeated every 21 days). These drugs are administered for 6 cycles.
After the first few cycles of therapy, it is advisable to look out for the possible emergence of a miasteniforme syndrome due to massive tumor cytolysis and the disposal of substances disturbing nerve conduction through the circulation.
Since the SC originates from neuroendocrine cells, it often presents a strong neuroendocrine component related to the originating tissue. This characteristic should be verified by measuring the plasma CgA values or by octreoscan (x-ray procedure that verifies if the cancer has receptors that can bind octreotide).
If a neuroendocrine active component shoud be present, it is possible to combine octreotide with the standard therapy on order to have benefits in terms of disease control.
The more effective second line therapy for this disease relies on topotecan.
However, we mustn't forget, other active drugs such as the anthracyclines (doxorubicin and epitubicina), irinotecan, carboplatin, the taxanes.
Hyperthermia is used in cases of localization of radiologically documented disease. It can get a better local response time and is especially recommended in case of "strategic" injury, e.g. if the desease causes problems through compression and pain.
Obviously, the effect will be greater in combination with chemotherapy or radiotherapy.
Dr. Carlo Pastore