# Limited-stage small-cell lung cancer

Source: https://onco.cc/cancers/limited-stage-sclc/  
OnCo record `limited-stage-sclc` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Small-cell lung cancer that is still confined to one side of the chest is treated to cure with chemotherapy and radiotherapy given together. Adding two years of the immunotherapy antibody durvalumab afterwards lengthened median survival from under three years to over four and a half, the first improvement in this disease in decades.

## Summary

Small-cell lung cancer grows fast, spreads early and responds dramatically but briefly to chemotherapy. Limited-stage disease, defined since the 1950s as disease encompassable in one radiation field, is treated with four cycles of cisplatin or carboplatin plus etoposide and concurrent thoracic radiotherapy started with the first or second cycle. Turrisi's trial (1999) showed that 45 Gy in twice-daily fractions over three weeks improved five-year survival from 16 to 26 percent compared with the same dose once daily, and CONVERT (2017) found that 66 Gy once daily was not better than the twice-daily schedule, so both are accepted. Prophylactic cranial irradiation for patients in response cut brain relapse and improved three-year survival from 15 to 21 percent in the 1999 Aupérin meta-analysis, though MRI surveillance is being tested as an alternative because of its effect on memory.

For twenty-five years nothing improved on this until ADRIATIC (2024): 730 patients without progression after chemoradiation were randomised to durvalumab for up to two years, placebo, or durvalumab plus tremelimumab. Durvalumab alone lengthened median overall survival from 33.4 to 55.9 months (hazard ratio 0.73) and progression-free survival from 9.2 to 16.6 months, with pneumonitis of any grade in about a third of patients in both arms. The FDA approved durvalumab consolidation in December 2024 and it has become the standard.

The next steps are testing the DLL3 T-cell engager tarlatamab after chemoradiation (DeLLphi-306) and checkpoint inhibitors given during rather than after chemoradiation; surgery is limited to the rare stage I tumour found incidentally. Open questions are whether prophylactic cranial irradiation is still needed with modern MRI surveillance, the best radiotherapy dose and schedule with immunotherapy, and how to treat the majority who still relapse.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: LS-SCLC; Limited-disease small-cell lung cancer; Stage I to III small-cell lung cancer
- Tags: subtype-page; lung
- Group: lung
- Burden: About 30 percent of small-cell lung cancers are limited stage, confined to one side of the chest and its regional nodes so that they fit in a single radiotherapy field; almost all patients are current or former heavy smokers. Median survival was 25 to 30 months with chemoradiation and about a fifth to a quarter were cured.
- Subtypes: Limited-stage small-cell lung cancer, stage I to III, fit for concurrent chemoradiation (durvalumab consolidation); Very limited stage I small-cell lung cancer (surgery then chemotherapy); Limited-stage small-cell disease unfit for concurrent treatment (sequential chemoradiation); Small-cell lung cancer transformed from EGFR-mutated adenocarcinoma
- Biomarkers: Stage by PET-CT and brain MRI (limited versus extensive is the main decision); Response after chemoradiation (eligibility for durvalumab); Pulmonary function and radiation dose constraints; Neuroendocrine markers on pathology (synaptophysin, chromogranin, INSM1); Transcription factor subtype (ASCL1, NEUROD1, POU2F3; research)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/limited-stage-sclc/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/limited-stage-sclc/#overview [4 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/limited-stage-sclc/#what-it-is [4 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/limited-stage-sclc/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/limited-stage-sclc/#treating-it [4 settings, 3 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/limited-stage-sclc/#evidence [25 trials, 4 key papers, 5 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/limited-stage-sclc/#science [6 targets, 3 pathways]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/limited-stage-sclc/where-you-are/ [34 UK centres]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/limited-stage-sclc/#living-with-it [18 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/limited-stage-sclc/coming/ [9 medicines, 24 trials, 3 ideas, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/limited-stage-sclc/data/ [79 connected records]

## Standard of care

- Limited stage, fit: Four cycles of cisplatin or carboplatin plus etoposide with concurrent thoracic radiotherapy (45 Gy twice daily or 60 to 66 Gy once daily) started by cycle two, then durvalumab for up to two years in patients without progression (ADRIATIC). ([Platinum + etoposide (EP / CE)](https://onco.cc/drugs/platinum-etoposide/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Etoposide](https://onco.cc/drugs/etoposide/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [CONVERT](https://onco.cc/trials/convert/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [ADRIATIC](https://onco.cc/trials/adriatic/), [Consolidation therapy](https://onco.cc/terms/consolidation-therapy/))
- After response: brain: Prophylactic cranial irradiation (25 Gy in 10 fractions) or MRI surveillance every three months in patients who decline it or are older; hippocampal avoidance where available. ([Prophylactic cranial irradiation vs MRI surveillance](https://onco.cc/technologies/prophylactic-cranial-irradiation/), [Prophylactic cranial irradiation (PCI)](https://onco.cc/terms/pci-term/), [MRI](https://onco.cc/technologies/mri/), [MRI surveillance replaces prophylactic cranial irradiation in SCLC](https://onco.cc/ideas/idea-mri-surveillance-replaces-pci/))
- Stage I, node-negative, found incidentally: Lobectomy with node dissection then four cycles of platinum-etoposide; radiotherapy if nodes are positive. ([Lobectomy](https://onco.cc/terms/lobectomy/), [Platinum + etoposide (EP / CE)](https://onco.cc/drugs/platinum-etoposide/))
- Relapse: As for extensive-stage disease: tarlatamab, lurbinectedin or topotecan, or rechallenge with platinum-etoposide if relapse is late. ([Tarlatamab](https://onco.cc/drugs/tarlatamab/), [DeLLphi-304](https://onco.cc/trials/dellphi-304/), [Lurbinectedin](https://onco.cc/drugs/lurbinectedin/), [Topotecan](https://onco.cc/drugs/topotecan/), [Platinum + etoposide (EP / CE)](https://onco.cc/drugs/platinum-etoposide/))

## State of the art

- Durvalumab consolidation after chemoradiation (ADRIATIC): median survival 55.9 versus 33.4 months.
- Twice-daily 45 Gy or once-daily 60 to 66 Gy thoracic radiotherapy, both accepted (CONVERT).
- MRI surveillance under test as an alternative to prophylactic cranial irradiation.
- Tarlatamab after chemoradiation in phase 3 (DeLLphi-306).

## Open problems

- Whether prophylactic cranial irradiation still helps when MRI surveillance is available is being tested in randomised trials.
- The best radiotherapy dose and schedule to combine with immunotherapy is unknown.
- Most patients still relapse after chemoradiation and durvalumab, and there is no biomarker for who will be cured.
- Transformed small-cell disease arising from EGFR-mutated adenocarcinoma is treated as limited or extensive stage without evidence specific to it.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Small-cell_carcinoma
- Wikipedia: https://en.wikipedia.org/wiki/Small-cell_carcinoma
- NCCN Guidelines: Small Cell Lung Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1462

## Connected records

- cancers: [Extensive-stage small-cell lung cancer](https://onco.cc/cancers/extensive-stage-sclc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MRI](https://onco.cc/technologies/mri/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Platinum agents](https://onco.cc/technologies/platinum/), [Prophylactic cranial irradiation vs MRI surveillance](https://onco.cc/technologies/prophylactic-cranial-irradiation/), [T-cell engagers (bispecific)](https://onco.cc/technologies/t-cell-engager/)
- targets: [DLL3](https://onco.cc/targets/dll3/), [PD-L1](https://onco.cc/targets/pdl1/), [TP53](https://onco.cc/targets/tp53/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Etoposide](https://onco.cc/drugs/etoposide/), [Lurbinectedin](https://onco.cc/drugs/lurbinectedin/), [Platinum + etoposide (EP / CE)](https://onco.cc/drugs/platinum-etoposide/), [Tarlatamab](https://onco.cc/drugs/tarlatamab/), [Topotecan](https://onco.cc/drugs/topotecan/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- companies: [Amgen](https://onco.cc/companies/amgen/), [AstraZeneca](https://onco.cc/companies/astrazeneca/)
- pathways: [p53 / RB / cell-cycle checkpoint](https://onco.cc/pathways/p53-cell-cycle/), [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/), [Small cell lung cancer (KEGG map)](https://onco.cc/pathways/sclc-signalling/)
- terms: [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Consolidation therapy](https://onco.cc/terms/consolidation-therapy/), [Histologic transformation](https://onco.cc/terms/histologic-transformation/), [Limited-stage vs extensive-stage (small-cell lung cancer)](https://onco.cc/terms/limited-extensive-stage/), [Lobectomy](https://onco.cc/terms/lobectomy/), [Prophylactic cranial irradiation (PCI)](https://onco.cc/terms/pci-term/), [Radiation pneumonitis and lung fibrosis](https://onco.cc/terms/radiation-pneumonitis/), [Small-cell lung cancer transcription-factor subtypes (SCLC-A, SCLC-N, SCLC-P, SCLC-I) and SLFN11](https://onco.cc/terms/sclc-molecular-subtypes/)
- trials: [A Clinical Study of TQB2450 Combined With Anlotinib in Limited-Stage Small Cell Lung Cancer Patients](https://onco.cc/trials/nct06469879/), [A Phase II Clinical Study of SHR-7787 Injection Combined With SHR-1316 Injection in Patients With LS-SCLC](https://onco.cc/trials/nct07798947/), [A Phase II Study of Tislelizumab Plus Anlotinib Consolidation After Chemoradiotherapy in LS-SCLC](https://onco.cc/trials/nct07815223/), [A Study of AK112 as Consolidation Treatment for Patients With Limited Stage Small-cell Lung Cancer Who Have Not Progressed Following Concurrent Chemor](https://onco.cc/trials/nct07010263/), [A Study of HS-20093 vs Active Surveillance in Limited-Stage Small Cell Lung Cancer](https://onco.cc/trials/nct06526624/), [a Study of QL1706 or QL1604 in Patients With Limited-stage Small Cell Lung Cancer After Chemoradiotherapy](https://onco.cc/trials/nct06789796/), [A Study to Evaluate the Efficacy and Safety of Serplulimab in Combination With Chemotherapy and Concurrent Radiotherapy in Patients With Limited-Stage](https://onco.cc/trials/nct05353257/), [ADRIATIC](https://onco.cc/trials/adriatic/), [CONVERT](https://onco.cc/trials/convert/), [DeLLphi-304](https://onco.cc/trials/dellphi-304/), [Dose-Escalation Radiotherapy in Limited-Stage Small Cell Lung Cancer: A Phase III Randomized Trial](https://onco.cc/trials/nct07015892/), [Durvalumab After Chemoradiotherapy in Limited Stage Small Cell Lung Cancer.](https://onco.cc/trials/nct06992609/), [Effect of Trilaciclib in the Prevention of Myelosupression in Subjects With Limited-stage Small Cell Lung Cancer](https://onco.cc/trials/nct07473128/), [Efficacy and Safety of Prophylactic Cranial Irradiation Versus MRI Surveillance in Patients With Limited-stage Small Cell Lung Cancer Who Achieved Remission Aft](https://onco.cc/trials/nct04829708/), [Intergroup 0096 (Turrisi): twice-daily versus once-daily thoracic radiotherapy](https://onco.cc/trials/turrisi-intergroup-0096/), [MOnaliZumab in Combination With durvAlumab (MEDI4736) for tRreatmenT of Small Cell Lung Cancer](https://onco.cc/trials/nct05903092/), [Omitting CTV for Primary Tumor in LS-SCLC](https://onco.cc/trials/nct07008716/), [Placebo-controlled, Study of Concurrent Chemoradiation Therapy With Pembrolizumab Followed by Pembrolizumab and Olaparib in Newly Diagnosed Treatment-](https://onco.cc/trials/nct04624204/), [Prophylactic Cranial Irradiation Overview (Auperin meta-analysis)](https://onco.cc/trials/pci-overview-1999/), [S1827 (MAVERICK) Testing Whether the Use of Brain Scans Alone Instead of Brain Scans Plus Preventive Brain Radiation Affects Lifespan in Patients With Small Cel](https://onco.cc/trials/nct04155034/), [Study Evaluating Tarlatamab After Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer (LS-SCLC)](https://onco.cc/trials/nct06117774/), [Sugemalimab as Consolidation Therapy in Patients With LS-SCLC Following cCRT or sCRT](https://onco.cc/trials/nct05623267/), [Tarlatamab and Durvalumab vs. Durvalumab Alone for Limited-Stage-Small Cell Lung Cancer](https://onco.cc/trials/nct07637513/), [Testing the Addition of a New Immunotherapy Drug, Atezolizumab (MPDL3280A), to the Usual Chemoradiation (CRT) Therapy Treatment for Limited Stage Small Cell Lun](https://onco.cc/trials/nct03811002/), [The Efficiency of Surgery and Radiotherapy After SHR-1316 (Adebrelimab) and Platinum-containing Doublet Induction Therapy for Limited-stage Small Cell Lung Canc](https://onco.cc/trials/nct05496166/)
- people: [Charles M. Rudin](https://onco.cc/people/charles-rudin/), [Fiona Blackhall](https://onco.cc/people/fiona-blackhall/), [Luis Paz-Ares](https://onco.cc/people/luis-paz-ares/), [Ying Cheng](https://onco.cc/people/cheng-ying/)
- key papers: [ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer](https://onco.cc/key-papers/paper-adriatic-nejm-2024/), [Molecular subtypes of small cell lung cancer: a synthesis of human and mouse model data](https://onco.cc/key-papers/paper-rudin-sclc-molecular-subtypes-nat-rev-cancer-2019/), [Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission](https://onco.cc/key-papers/paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999/), [Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide](https://onco.cc/key-papers/paper-turrisi-twice-daily-thoracic-radiotherapy-limited-sclc-nejm-1999/)
- ideas: [MRI surveillance replaces prophylactic cranial irradiation in SCLC](https://onco.cc/ideas/idea-mri-surveillance-replaces-pci/), [Run small-cell lung cancer as one platform with shared controls and subtype stratification](https://onco.cc/ideas/idea-lung-small-cell-platform-with-shared-controls-and-subtypes/), [Subtype-directed therapy for SCLC (ASCL1 / NEUROD1 / POU2F3 / inflamed)](https://onco.cc/ideas/idea-sclc-subtype-directed/)

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JSON: https://onco.cc/api/v1/entities/limited-stage-sclc.json