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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.
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.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
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.
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Large cell neuroendocrine carcinoma of the lung, Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
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Also on OnCo: Symptoms and red flags · Early detection roadmap.
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).
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.
Lobectomy with node dissection then four cycles of platinum-etoposide; radiotherapy if nodes are positive.
As for extensive-stage disease: tarlatamab, lurbinectedin or topotecan, or rechallenge with platinum-etoposide if relapse is late.
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Patients with limited-stage small-cell lung cancer who complete chemoradiotherapy without progression should now be offered up to two years of durvalumab consolidation, which extends life by almost two years on average. This is the first survival improvement for limited-stage disease since twice-daily radiotherapy and prophylactic cranial irradiation, and small-cell lung cancer is no longer a disease where immunotherapy gives only marginal gains.
The organising framework for every small-cell lung cancer trial designed since. It is also why the slow progress in the disease is now attributed to treating four diseases as one rather than to the biology being intractable.
Treating the brain before the cancer gets there works in small-cell lung cancer, and it is the proof of principle behind every later attempt to prevent rather than treat brain metastases.
The standard of care in limited-stage small-cell lung cancer from 1999 until ADRIATIC added immunotherapy in 2024, and a rare example of a curative gain in a disease that has had almost none.
Query for this cancer: (TITLE:"Limited-stage small-cell lung cancer" OR ABSTRACT:"Limited-stage small-cell lung cancer" OR TITLE:"LS-SCLC" OR ABSTRACT:"LS-SCLC" OR TITLE:"Limited-disease small-cell lung cancer" OR ABSTRACT:"Limited-disease small-cell lung cancer" OR TITLE:"Stage I to III small-cell lung cancer" OR ABSTRACT:"Stage I to III small-cell lung cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Limited-stage small-cell lung cancer, not a curated reading list.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Fever of 38 C or higher, chills, low blood pressure, fast heartbeat or breathlessness, especially after a step-up dose. Boxed warning on teclistamab, epcoritamab, glofitamab, tarlatamab and blinatumomab.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Dose by Calvert formula using GFR (see the calculators).
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Reduce to 75% for CrCl 15-50.
See all on the product pages:CarboplatinCisplatinDurvalumabEtoposideLurbinectedinPlatinum + etoposide (EP / CE)TarlatamabTopotecan·Printable cards in the navigator
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