A 60-year-old woman with a mass in the right pulmonary hilum is found by spectrum cytology to have a small cell carcinoma. At this time, appropriate management is to
|A||Begin chemotherapy and radiation therapy|
|B||Carry out a metastatic workup including CT Scans of the head and the liver|
|D||Perform right thoracotomy and pneumonectomy|
a. SCLC is a chemotherapy-sensitive disease.
b. Patients with limited stage disease have high response rates (60–80%) and a 10–30% complete response rate.
c. The response rates in patients with extensive disease are somewhat lower (50%) and almost always partial responses. Tumor regressions usually occur quickly, within the first two cycles of treatment, and provide rapid palliation of tumor-related symptoms.
d. Chemotherapy significantly prolongs survival.
e. Untreated, patients with limited-stage SCLC have a median survival of 12 weeks; the median survival with chemotherapy is 18 months, and long-term (>3 year) survival is 30–40%. The median survival of extensive-stage patients is 9 months; <5% of patients survive 2 years.
f. Radiation therapy to the thorax is associated with a small but significant improvement in long-term survival for patients with limited-stage SCLC (5% at 3 years).
g. Chemotherapy given concurrently with thoracic radiation is more effective than sequential chemoradiation but is associated with significantly more esophagitis and hematologic toxicity.
h. PCI significantly decreases the development of brain metastases (which occur in about two-thirds of patients who do not receive PCI) and results in a small survival benefit (~5%) in patients who have obtained a complete response to induction chemotherapy