The treatment of limited small cell lung cancer: a report of the progress made and future prospects.

The improvements in the treatment of small cell lung cancer over the last 30 years have been realised by understanding that it is a systemic disease, but that areas of bulk and sanctuary require a complementary therapy. Despite successful strategies using combinations and thoracic radiotherapy, there remains uncertainty about what the best regimens are, their timing and their intensity. However, earlier concurrent therapy and rather brief intense chemotherapy and radiotherapy seem to produce the best results in moderately fit patients of all ages. How to select the fit patients and what to do about the less fit ones remains controversial and have economic consequences for governments and payers. Despite a meta-analysis demonstrating the success of prophylactic cranial irradiation (PCI), doubts linger about its safety, despite nothing more than anecdotal evidence from a previous era. The role of surgery continues to be explored, more in Europe than North America or Asia. Strategies for treatment of minimum residual disease seem a focus. New drugs, molecular targeted therapy, immunotherapy and other molecular therapies offer promise and theory, but there is little evidence about their place in the treatment protocols of today.

Platinum combined with radiation therapy in small cell lung cancer: focusing like a laser beam on crucial issues.

The addition of radiotherapy to combination chemotherapy has been shown to improve survival for patients with limited small cell lung cancer (SCLC). Although SCLC is very sensitive to radiotherapy, the impact of radiation may be confounded by interaction among various radiotherapy factors or by the chemotherapeutic agents used in combination. The potential effects of such radiation factors as dose, volume, fractionation, sequence with chemotherapy, and timing (early v late), as well as choice of chemotherapy, therefore must be carefully considered when designing or comparing clinical trials of combined modality therapy for SCLC. The combination of thoracic radiotherapy plus platinum-based chemotherapy currently represents the cornerstone of such combination treatment for SCLC. Many questions remain, however, and it is hoped that new trials will be designed to focus more precisely on unsettled issues.

Radiation therapy as an alternative to surgery in the management of intracranial juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma is a benign, vascular tumor which typically presents in adolescent males. Although surgical resection is usually recommended for the management of this tumor, external beam radiation therapy has also been advocated in the literature. We report three cases of large juvenile nasopharyngeal angiofibromas with extensive intracranial extension primarily managed with external beam radiation therapy. Although there was not complete resolution of the tumors, there was significant alleviation of symptomatology with no serious side effects from the radiation therapy. Based on these cases, we feel that external beam radiation therapy in the management of extensive juvenile nasopharyngeal angiofibromas with intracranial extension is warranted in certain select cases.