Carcinomes bronchiques à petites cellules limités : traitement standard et nouvelles approches thérapeutiques

Small cell carcinomas are aggressive on account of their high and early risk of dissemination. They represent less than 20 % of all lung cancers and only a third of these patients present limited stage disease at diagnosis. Currently, treatment is based on conformational thoracic irradiation and chemotherapy combining platinum and etoposide. Because of the high risk of brain metastases, prophylactic cranial irradiation (PCI) is indicated in patients with a complete response in limited disease. Progress is the consequence of a better combination of thoracic and cerebral irradiation with poly chemotherapy. Many issues are subject to further clinical research concerning systemic treatment which is the pivotal treatment, modalities of combination radio-chemotherapy, radiotherapy target volumes, optimum dose and drugs used in association with irradiation. New approaches such as immune therapy should be evaluated.