Anne Kessinger, MD

Despite a decreasing incidence in the United States, small-cell lung cancer (SCLC) remains a major clinical problem, with approximately 30,000 new cases each year. The diagnosis of SCLC is usually not difficult. The Veterans Administration Lung Study Group (VALSG) staging system is less accurate than the American Joint Committee of Cancer tumor-node-metastasis (TNM) system (7th edition) at predicting survival in SCLC, especially in lower stage disease. Surgery has not played a major part in the management of SCLC, but emerging data suggest that resection may have a role in earlier stage disease. While the frontline treatment of SCLC has not changed significantly in the past decade, newer agents that are currently being investigated provide hope for better treatment of relapsed/refractory disease for the future.

Almost 40% of patients with newly diagnosed small-cell lung cancer (SCLC) have disease confined to the ipsilateral hemithorax and within a single radiation port, ie, limited-stage disease. The median survival for this group of patients after treatment is approximately 15 months, with one in every four patients surviving 2 years. Current optimal treatment consists of chemotherapy with platinum/etoposide, given concurrently with thoracic radiation. Surgery may represent an option for very early-stage disease, but its added value is uncertain. Prophylactic cranial irradiation (PCI) is used for patients with limited-stage SCLC who have achieved a complete response following initial therapy, as it decreases the risk of brain metastases and provides an overall survival benefit. Newer targeted agents are currently being evaluated in this disease and hold the promise of improving current outcomes seen in patients with early-stage disease.

The role of screening in order todetect lung cancer at an earlierstage has been widely debatedfor the past 4 decades. In this review,Dr. Mulshine focuses on the currentissues in lung cancer screening in lightof the findings of the InternationalEarly Lung Cancer Action Project(I-ELCAP) As the article mentions, thediagnosis of lung cancer is often madeat a stage when the disease is no longer amenable to cure. This is probably themost important cause for the dismaloutcomes of patients with lung canceroverall.

Over the past 2 decades, advances in clinical oncology have occurred at a whirlwind pace, as new surgical, diagnostic, preventive, immunotherapeutic, chemotherapeutic, radiotherapeutic, and molecular resources and techniques have become available. As one result, the death rate from cancer in the United States has decreased during the past decade.[1] Thanks to these advances, many patients have replaced feelings of hopelessness with hope for a cure.