A 68-year-old man is diagnosed with localised small-cell lung cancer (SCLC), limited-stage (disease confined to one hemithorax, encompassable in a radiation field). The CURRENT standard of care for limited-stage SCLC is:
- A Surgery followed by adjuvant chemotherapy
- B Immunotherapy (atezolizumab) plus chemotherapy without radiation
- C Radiation alone as SCLC is extremely radiosensitive
- D Concurrent chemoradiotherapy (cisplatin + etoposide × 4 cycles with concurrent thoracic RT starting with cycle 1–2) followed by prophylactic cranial irradiation (PCI) if response achieved ✓
Explanation
Limited-stage SCLC (confined to one hemithorax including mediastinum and ipsilateral supraclavicular nodes) is treated with concurrent chemoradiotherapy: cisplatin + etoposide for 4 cycles combined with thoracic radiotherapy starting early (cycle 1 or 2), which improves survival over sequential treatment. Prophylactic cranial irradiation (PCI) is offered to patients achieving complete or partial response, as SCLC has a 50–70% risk of brain metastases at 2 years; PCI reduces this risk and improves survival. The CASPIAN and IMpower133 trials added immunotherapy for extensive-stage SCLC but not limited-stage.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.