Imaging-guided adaptive radiation therapy in limited-stage small cell lung cancer: Current evidence and clinical perspectives

doi:10.4329/wjr.124830

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World Journal of Radiology

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1949-8470

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Radiol. Aug 28, 2026; 18(8): 124830
Published online Aug 28, 2026. doi: 10.4329/wjr.124830

Imaging-guided adaptive radiation therapy in limited-stage small cell lung cancer: Current evidence and clinical perspectives

Omer Sager

Omer Sager, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Türkiye

Author contributions: Sager O contributed solely to the design of the manuscript, the acquisition and interpretation of data, and the drafting and revision of the manuscript for important intellectual content. The author has read and approved the final manuscript.

AI contribution statement: Artificial intelligence (AI)-based language assistance tools were used solely to improve the readability and presentation of the manuscript. Specifically, these tools were utilized for: Improving grammar, spelling, punctuation, and sentence structure; rephrasing selected paragraphs to enhance clarity and academic language; improving transitions between sections and reducing linguistic redundancy; assisting with formatting and organization of the manuscript text. Importantly, AI tools were not used to generate original scientific concepts, formulate the study hypothesis, design the methodology, perform data collection, conduct statistical analyses, interpret results, generate figures or tables, create references, or draw scientific conclusions. All scientific content, including the design, data analyses, interpretation of findings, and final conclusions, originated entirely from the author. Furthermore, every AI-assisted revision underwent comprehensive manual review by the author. All text generated or modified with AI assistance was carefully verified for scientific accuracy, factual correctness, appropriate citations, and consistency with the original data. The author assumes full responsibility for the integrity, accuracy, and originality of the manuscript.

Conflict-of-interest statement: The author declares that he has no conflict of interest to disclose.

Corresponding author: Omer Sager, MD, Professor, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, 06018 Etlik Ankara Ankara 0090, Türkiye. omersager@gmail.com

Received: June 25, 2026
Revised: July 21, 2026
Accepted: August 3, 2026
Published online: August 28, 2026
Processing time: 64 Days and 2.2 Hours

Abstract

Small cell lung cancer (SCLC) remains among the most aggressive thoracic malignancies and continues to present major therapeutic challenges despite advances in multimodality treatment. Limited-stage SCLC (LS-SCLC), representing approximately one-third of cases, is conventionally managed with concurrent chemoradiotherapy delivered with curative intent. Radiation therapy (RT) is central to treatment; however, rapid treatment related anatomical and volumetric changes may alter target geometry and reduce the accuracy of plans generated from baseline imaging. Adaptive RT (ART) has emerged as an imaging-guided strategy that enables treatment modification according to evolving anatomy during RT delivery. This narrative review examines the rationale and current evidence supporting imaging-guided ART in LS-SCLC, with emphasis on imaging-informed decision-making and contemporary implementation considerations. LS-SCLC represents a biologically compelling setting for adaptive treatment because of its rapid treatment responsiveness; however, important uncertainties remain regarding patient selection, imaging schedules, adaptive triggers, and workflow standardization. Prospective studies incorporating standardized adaptive workflows and clinically meaningful endpoints are required to determine whether observed dosimetric advantages translate into measurable clinical benefit.

Keywords: Adaptive radiation therapy; Limited-stage small cell lung cancer; Image-guided radiotherapy; Cone-beam computed tomography; Adaptive replanning; Thoracic radiotherapy

Core Tip: Adaptive radiation therapy (ART) is a viable treatment strategy accounting for changes in tumor size and anatomy during the course of irradiation. Limited-stage small cell lung cancer (LS-SCLC) may be well suited for ART since it responds well to both chemotherapy and radiation therapy. Despite paucity of high level evidence, several studies have investigated ART for LS-SCLC and have reported promising results. Changes that could be accounted for by ART may include tumor regression or progression, atelectasis, pleural effusion, anatomical shifts, and infiltrative changes.