American Board of Internal Medicine (ABIM) Certification Practice Exam

What is indicated for treatment of limited-stage small cell lung cancer that is too advanced for surgical resection?

1. Only chemotherapy

2. Surgery only

3. Chemotherapy and radiation therapy

4. Targeted therapy

The correct answer is: Chemotherapy and radiation therapy

For patients with limited-stage small cell lung cancer (SCLC) that cannot be treated with surgical resection due to the extent of the disease, the optimal treatment approach is chemotherapy combined with radiation therapy. This multimodal treatment strategy is supported by clinical evidence, demonstrating that the addition of radiation to chemotherapy enhances the overall survival rates in this subgroup of patients. In limited-stage SCLC, which is typically defined as cancer that has not spread beyond the lung and the regional lymph nodes, the goal is to achieve a comprehensive approach that addresses both the primary tumor and the potential micrometastatic disease. Chemotherapy can help to manage systemic disease, while radiation therapy targets the primary tumor site to maximize local control, reduce the risk of recurrence, and improve symptoms. While chemotherapy alone can manage limited-stage SCLC, incorporating radiation has been shown to provide significant benefits, particularly in terms of improving survival outcomes. Other treatments, such as surgery or targeted therapy, are not appropriate in this context. Surgery is typically not feasible in advanced stages where complete resection is not possible, and targeted therapies are not standard in the management of SCLC, as this type of cancer primarily relies on conventional cytotoxic chemotherapy and radiation efficacy rather than targeted approaches.