Limited small-cell lung cancer: A potentially curable disease

Patients with limited-stage small-cell carcinoma of the lung are treated wi th combined-modality therapy with the intent to cure. Standard therapy cons ists of platinum-based combination chemotherapy, thoracic irradiation, and for responders, prophylactic cranial irradiation. Despite this aggressive a pproach, too few patients achieve 5-year survival. In the past several year s, new chemo-therapeutic agents, including the taxanes and the topoisomeras e I inhibitors, have demonstrated substantial activity against small-cell c arcinoma. These agents are now being incorporated hto clinical trials for p atients with limited-stage disease. The best combination of these agents wi th platinum-base regimens is yet to be determined, and data supporting incr eased survival are awaited. Other studies are exploring thoracic radiation issues. Questions remain regarding optimal timing, dose, volume, and fracti onation schemes. The most effective combination of thoracic irradiation and the newer chemotherapy agents also remains to be determined. The current a pproach to limited-stage small-cell carcinoma is reviewed, ongoing trials a re described, and future directions are explored.