Untreated small-cell lung cancer (SCLC) is highly sensitive to both chemotherapy and radiotherapy, although its growth is quite rapid. Clinically, SCLC is classified into limited disease (LD) and extensive disease (ED). Although there are no distinct criteria, LD is generally accepted to be a disease which is confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes without malignant effusion, i.e., a disease in which curative radiotherapy is applicable. Nearly 30% of SCLC is LD at the initial diagnosis. LD-SCLC is a potentially curable disease, and standard treatment is chemoradiotherapy, and the concurrent use of chemotherapy and radiotherapy is chosen particularly if the performance status of the patient is 2 or less and the organ function is good. Cisplatin plus etoposide is typically administered together with radiotherapy, since the risk of radiation pneumonia is known to be low when this combination is selected. The median survival time of LD-SCLC is 16 to 24 months and the 5-year survival rate is nearly 15%. Conversely, the median survival time of ED-SCLC is 6-12 months, however, a long-term disease-free survival is rare. Chemotherapy alone is chosen for ED-SCLC. In the Japanese guideline, the combination of cisplatin plus irinotecan is the first choice if tolerable.
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