Advances in the management of small cell lung cancer: thoracic and cranial radiation therapy and sequencing with systemic therapy

Small cell lung cancer (SCLC) is a highly aggressive malignancy that is characterised by rapid proliferation and early metastatic dissemination. This review outlines the advances in management strategies for very limited-stage (VLS-SCLC), limited-stage (LS-SCLC) and extensive-stage (ES-SCLC) disease, with emphasis on recent advances in thoracic radiation therapy (TRT) techniques and dose fractionation, as well as the integration of systemic treatments including immuno-oncological therapies (IO). Given the high incidence of cerebral metastases, contemporary cranial radiation techniques will be examined, including hippocampal avoidance (HA) and stereotactic radiosurgery (SRS), as well as the evolving role of prophylactic cranial irradiation (PCI) in the setting of routine magnetic resonance imaging (MRI) surveillance.