https://www.cancer.org/cancer/lung-cancer/treating-small-cell/by-stage.html
Treatment Choices for Small Cell Lung Cancer, by Stage
For practical reasons, small cell lung cancer (SCLC) is usually staged as either limited or extensive. In most cases, SCLC has already spread by the time it is found, so chemotherapy (chemo) is usually part of treatment.
If you smoke, one of the most important things you can do to be ready for treatment is to quit. Studies have shown that patients who stop smoking after a diagnosis of lung cancer tend to have better outcomes than those who don’t.
Treating limited stage SCLC
Stage I cancers
If you only have one small tumor in your lung and there is no evidence of cancer in lymph nodes or elsewhere, your doctors might recommend surgery to remove the tumor and the nearby lymph nodes.
Before the operation, the lymph nodes in your chest will be checked for cancer with mediastinoscopy or other tests, because surgery is unlikely to be a good option if the cancer has spread there.
Surgery is generally followed by chemotherapy. If cancer is found in the lymph nodes that were removed, radiation therapy to the chest is also usually recommended. The radiation is often given at the same time as the chemo. Although this increases the side effects of treatment, it appears to be more effective than giving one treatment after the other. If you already have severe lung disease (in addition to your cancer) or other serious health problems, you might not be given radiation therapy.
Other limited stage cancers
For most people with limited stage SCLC, surgery is not an option because the tumor is too large, it’s in a place that can’t be removed easily, or it has spread to nearby lymph nodes or other lobes in the same lung. If you are in good health, the standard treatment is chemo plus radiation to the chest given at the same time (called concurrent chemoradiation). The chemo drugs used are usually etoposide plus either cisplatin or carboplatin.
Concurrent chemoradiation can help people with limited stage SCLC live longer and give them a better chance at a cure than giving one treatment (or one treatment at a time). The downside is that this combination has more side effects than either chemo or radiation alone.
Treating extensive stage SCLC
Extensive stage SCLC has spread too far for surgery or radiation therapy to be useful as the initial treatment. If you have extensive SCLC and are in fairly good health, chemotherapy (chemo), possibly along with an immunotherapy drug, is typically the first treatment. This can often shrink the cancer, treat your symptoms, and help you live longer.
The most common combination of chemo drugs is etoposide plus either cisplatin or carboplatin. The immunotherapy drugs atezolizumab (Tecentriq) or durvalumab (Imfinzi) can be used along with etoposide and a platinum drug (cisplatin or carboplatin) for initial treatment and can then be continued alone as maintenance therapy. The cancer will shrink
