In summary, combination chemotherapy remains the mainstay of SCLC treatment. Patients with limited-stage disease should be treated aggressively. Under appropriate circumstances, using currently available treatment programs, approximately 2-25% of these patients will survive, free of disease, for 2-3 years. Thoracic irradiation and surgery add to our ability to control intrathoracic disease but as yet have had only minimal impact on survival. Nevertheless, investigation continues as to the exact role these treatment modalities will play in the overall management of SCLC. Extensive-stage patients are less curable and definitely should be considered for entrance into prospective clinical trials. However, even patients with widespread disease can be afforded a measure of palliation with currently available therapy. It is ironic that SCLC is almost completely preventable. An aggressive antismoking attitude is needed among primary-care physicians to help stem the increased incidence of this and other lung neoplasms. Although considerable effort has gone into understanding the biology and treatment of this neoplasm, more lives could be saved if smoking were actively discouraged. Until society comes to grips with this simple fact, our efforts to manage SCLC better must continue.
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