![]() Adding TRT increases absolute survival by approximately 5% over chemotherapy alone. 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. Improved long-term survival in patients with LD has been shown with combined-modality therapy. Patients diagnosed with LD who smoke should be encouraged to stop smoking before undergoing combined-modality therapy because continued smoking may compromise survival. For patients with LD, median survival of 16 to 24 months and 5-year survival rates of 14% with current forms of treatment have been reported. Patients with LD have a better prognosis than patients with ED. The overall survival rate at 5 years is 5% to 10%.Īn important prognostic factor for SCLC is the extent of disease. However, even these patients are at risk of dying from lung cancer (both small and non-small cell types). About 10% of the total population of SCLC patients remains free of disease during the 2 years from the start of therapy, which is the time period during which most relapses occur. Without treatment, SCLC has the most aggressive clinical course of any type of pulmonary tumor, with a median survival from diagnosis of only 2 to 4 months. Regardless of stage, the current prognosis for patients with SCLC is unsatisfactory despite improvements in diagnosis and therapy during the past 25 years. Immunohistochemistry and electron microscopy are invaluable techniques for diagnosis and subclassification, but most lung tumors can be classified by light microscopic criteria.įor more information, see the Staging Evaluation section. This is critical because SCLC, which responds well to chemotherapy and is generally not treated surgically, can be confused on microscopic examination with NSCLC. Chest CT scan with infusion of contrast material.īefore a patient begins lung cancer treatment, an experienced lung cancer pathologist must review the pathological material.Miscellaneous treatments, including monoclonal antibody therapy, tamoxifen, and growth factor inhibition have not yet been shown to have a role in the treatment of SCLC. These trials are not yet mature and survival results are not available. In all trials, the matrix metalloproteinase inhibitor is administered after chemotherapy and radiotherapy as adjuvant treatment. The matrix metalloproteinase inhibitors marimastat and BMS-275291 are under evaluation in SCLC. Although one study of warfarin and another of heparin showed trends in favor of anticoagulant therapy, there has been little research over the past decade evaluating this form of treatment of SCLC. Trials of anticoagulant therapy using heparin, warfarin, and aspirin were undertaken in the 1980s and early 1990s. ![]() ![]() If results are promising, a phase III trial will be undertaken. In North America, a bivalent ganglioside vaccine, BMS-248967, is under study at the phase II level. An anti-idiotypic monoclonal antibody against the GD3 ganglioside, BEC-2, is being evaluated after chemotherapy in SCLC patients in a European study. Tumor vaccines against gangliosides that are expressed on almost all human SCLC cells have been recently developed. Different interferon preparations were used, but none of the trials showed a significant prolongation of survival. Interferon has been evaluated in four trials of adjuvant therapy after response to chemotherapy for SCLC. For this reason, investigators have turned to the evaluation of alternative treatment strategies for patients with this malignancy. Despite high initial response rates, most patients with small cell lung cancer (SCLC) relapse shortly after discontinuing therapy, and cure remains an elusive goal, even for patients with limited-stage disease. ![]()
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