[Small cell lung cancer]

With about 20% of all lung cancers small cell lung cancer (SCLC) represents a major subset of this entity. Although therapeutic improvements did not receive as much attention as in non small cell lung cancer (NSCLC), many small steps of clinical progress have been achieved within the last 20 years. An optimal treatment should be based on an interdisciplinary treatment plan. The standard treatment in localized stages represents combined radiation and chemotherapy. Cisplatin and etoposide are in this concern considered as a gold standard. 3D-planned conformal radiotherapy should start as early as possible and should be applied concomitantly to chemotherapy and in certain cases even in a hyperfractionated treatment protocol. In very early stages surgical resection could be an option in selected cases. In advanced stages a platinum-based doublet offers high response rates. As already established in limited disease prophylactic cranial irradiation is now also indicated in extensive disease in case of any tumor remission. In the second line treatment and in patients with reduced performance status topotecan is recommended. Similar as in NSCLC pemetrexed might become an alternative treatment option in the second line setting. In the field of new targeted therapies bevacizumab achieved the most promising results. The present review highlights historical milestones and up-to-date trends in radiotherapy, chemotherapy and surgery. Furthermore, the role of experimental strategies and the management of certain special clinical situations are discussed.

[Updated strategies in Small Cell Lung Cancer post ASCO 2007]

Small Cell Lung Cancer (SCLC) is associated with intensive nicotine consumption and characterized by a very aggressive growth rate. Furthermore, metastases often appear very early. At the annual meeting of the "American Society of Clinical Oncology" (ASCO) 2007, recent issues which will influence the daily clinical practice were presented. New chemotherapy combinations such as carboplatin/irinotecan or pemetrexed as well as targeted therapies e.g. bevacizumab in combination with chemotherapy could extend our therapeutic options. A genetic polymorphism, which influences the pharmacokinetic of irinotecan, turned out to be one reason for the different outcome of an irinotecan/cisplatin therapy in a Japanese and Northern American population. In the field of radiotherapy, a phase III study showed for the first time a significant benefit in overall survival by prophylactic cranial radiation in the setting of extensive disease.