Thoracic irradiation as consolidation therapy in patients with extensive-stage small cell lung cancer

• Published in: Current opinion in oncology Vol. 35; no. 1; pp. 54 - 60
• Main Authors: Berta, Judit, Rózsás, Anita, Megyesfalvi, Zsolt, Ostoros, Gyula, Döme, Balázs
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-01-2023
• Subjects: Cancer and Oncology; Cancer och onkologi; chemo-immunotherapy; Clinical Medicine; Consolidation Chemotherapy; consolidative thoracic radiation therapy; extensive-stage small cell lung cancer; Humans; Klinisk medicin; lung cancer; Lung Neoplasms - radiotherapy; Medical and Health Sciences; Medicin och hälsovetenskap; Small Cell Lung Carcinoma - radiotherapy
• ISSN: 1040-8746; 1531-703X
• DOI: 10.1097/CCO.0000000000000911

Small cell lung cancer (SCLC) is marked by an exceptionally high proliferative rate and poor prognosis. Given its high propensity to metastasize, nearly two-thirds of SCLC patients are diagnosed with extensive-stage (ES) disease when surgery is not a treatment option anymore. Over several decades, only minimal changes have been made in the therapeutic armamentarium of ES-SCLC. Recently, however, several new therapeutic avenues were defined, thus renewing the hope for patients with this recalcitrant cancer. Here, we present an overview of the most current therapeutic advances in ES-SCLC focusing in particular on consolidative thoracic radiation therapy (cTRT) and chemo-immunotherapy.
The incorporation of immunotherapy in the standard-of-care of ES-SCLC patients and the resulting outcomes are both a remarkable hallmark of progress and a disappointment. Indeed, chemo-immunotherapy with or without cTRT and prophylactic cranial irradiation contributes to longer survival outcomes with minimal toxicity rates in well selected and properly monitored patients. Nevertheless, the gain in overall survival is still modest relative to that seen in many other solid tumors.
Despite the encouraging results, further clinical trials are needed to determine the efficacy and safety of these therapeutic approaches, and moreover, to identify new predictive biomarkers of response.