Limited-stage small-cell lung cancer
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.
Overview
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.
State of the art
- 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).
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Durvalumab consolidation after chemoradiation (ADRIATIC): median survival 55.9 versus 33.4 months.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowCytokine release syndrome
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.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Check before combiningKidneys: Carboplatin
Dose by Calvert formula using GFR (see the calculators).
- Check before combiningKidneys: Cisplatin
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
- Check before combiningKidneys: Etoposide
Reduce to 75% for CrCl 15-50.
See all on the product pages:CarboplatinCisplatinDurvalumabEtoposideLurbinectedinPlatinum + etoposide (EP / CE)TarlatamabTopotecan·Printable cards in the navigator
Anatomy and lymph node drainage
- Central airways (squamous, small-cell)
- Periphery (adenocarcinoma)
- Apex (Pancoast)
- Pleura (mesothelioma)
- Thymus (anterior mediastinum)
- Nodes: hilar (N1)
- Nodes: mediastinal (N2)
- Nodes: supraclavicular (N3)
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.
- Central airways (squamous, small-cell)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
- Periphery (adenocarcinoma)Small-cell lung cancer transformed from EGFR-mutated adenocarcinoma
- Apex (Pancoast)
- Pleura (mesothelioma)
- Thymus (anterior mediastinum)Small-cell lung cancer transformed from EGFR-mutated adenocarcinoma
- hilar (N1)
- mediastinal (N2)
- supraclavicular (N3)
Same organ: 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)
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.
- MRIStandard of care
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
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.
Subtypes & biomarkers
top- 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
- 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)
How often this target appears
- 1957Veterans Administration Lung Study Group defines limited and extensive stage
- 1992Meta-analysis: adding thoracic radiotherapy to chemotherapy improves survival in limited stage
- 1999Turrisi: twice-daily 45 Gy improves five-year survival to 26 percent; Aupérin meta-analysis: prophylactic cranial irradiation improves survival
- 2017CONVERT: 66 Gy once daily not superior to 45 Gy twice daily
- 2024ADRIATIC: durvalumab after chemoradiation lengthens survival by almost two years; FDA approval
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 9 changes by month →- 2026-09-17This recordLimited-stage small-cell lung cancerFacts on this page last checked
When this page itself was last checked or edited.
- 2025Trial resultDeLLphi-304DeLLphi-304 reported
OS HR 0.
- 2024Trial resultADRIATICADRIATIC reported
OS 55.
- 2024MilestoneADRIATICADRIATIC: durvalumab after chemoradiation lengthens survival by almost two years; FDA approval
A milestone in how this cancer is treated.
- 2017Trial resultCONVERTCONVERT reported
No significant difference; twice-daily 45 Gy remains standard.
- 2017MilestoneCONVERTCONVERT: 66 Gy once daily not superior to 45 Gy twice daily
A milestone in how this cancer is treated.
What is in development for Limited-stage small-cell lung cancer, drawn from the whole corpus: 5 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Trials under way · 1
Trials reported · 2
Ideas not yet in a trial · 2
Open problems and what is being done
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.
and how the field plans to fix it →What is being done about thisRecurrence and residual diseaseAvailable now- LurbinectedinApproved
- TopotecanApproved
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Also on OnCo: Treatment journeys · Survivorship planner.
Transformed small-cell disease arising from EGFR-mutated adenocarcinoma is treated as limited or extensive stage without evidence specific to it.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Manchester · cancer center | United Kingdom | none recorded | 0 | 104 | 2,145 | #23 | |
London · consortium | United Kingdom | none recorded | 1 | not matched | - | none recorded | - |
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
| China | none recorded | 0 | 930 | 14,477 | - | ||
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - | |
| Spain | none recorded | 0 | 764 | 13,767 | - | ||
Würzburg · cancer center | Germany | none recorded | 0 | 760 | 11,806 | - | |
Dresden · cancer center | Germany | none recorded | 0 | 728 | 7,984 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - | ||
Aarhus · hospital | Denmark | none recorded | 0 | 624 | 4,497 | - | |
Freiburg im Breisgau · cancer center | Germany | none recorded | 0 | 549 | 5,261 | - | |
Geneva · hospital | Switzerland | none recorded | 0 | 441 | 6,485 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Limited-stage small-cell lung cancer but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Limited-stage small-cell lung cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Stage by PET-CT and brain MRI, Response after chemoradiation, Pulmonary function and radiation dose constraints, Neuroendocrine markers on pathology, Transcription factor subtype), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Limited-stage small-cell lung cancer, stage I to III, fit for concurrent chemoradiation, Very limited stage I small-cell lung cancer, Limited-stage small-cell disease unfit for concurrent treatment.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Limited stage, fit
- For my situation (limited stage, fit), which of the standard options do you recommend and why?Why: Guideline options include: 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).
- Am I a candidate for Platinum + etoposide (EP / CE), Cisplatin, Carboplatin or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of CONVERT and ADRIATIC apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
After response: brain
- For my situation (after response: brain), which of the standard options do you recommend and why?Why: Guideline options include: 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.
Stage I, node-negative, found incidentally
- For my situation (stage i, node-negative, found incidentally), which of the standard options do you recommend and why?Why: Guideline options include: Lobectomy with node dissection then four cycles of platinum-etoposide; radiotherapy if nodes are positive.
- Am I a candidate for Platinum + etoposide (EP / CE), and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Relapse
- For my situation (relapse), which of the standard options do you recommend and why?Why: Guideline options include: As for extensive-stage disease: tarlatamab, lurbinectedin or topotecan, or rechallenge with platinum-etoposide if relapse is late.
- Am I a candidate for Tarlatamab, Lurbinectedin, Topotecan or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of DeLLphi-304 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Study Evaluating Tarlatamab After Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer (LS-SCLC), Tarlatamab, MRI surveillance replaces prophylactic cranial irradiation in SCLC, Subtype-directed therapy for SCLC (ASCL1 / NEUROD1 / POU2F3 / inflamed)?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Whether prophylactic cranial irradiation still helps when MRI surveillance is available is being tested in randomised trials”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “The best radiotherapy dose and schedule to combine with immunotherapy is unknown”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Limited-stage small-cell lung cancer, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
10targets
6drugs
9companies
4pathways
3terms
7trials
4ideas
2people
4key papers
1Latest papers
topQuery 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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