Abstract
Small cell lung carcinoma represents 15–20% of lung cancer. Is is characterized by rapid growth and early disseminated disease with poor outcome. For many years surgery was considered a contraindication in Small Cell Lung Cancer (SCLC) since radiotherapy and chemoradiotherapy were found to be more efficient in the management of these patients. Never the less some surgeons continue to be in favor of surgery as part of a combined modality treatment in patients with SCLC. The revaluation of the role of surgery in this group of patients is based on clinical data indicating a much better prognosis in selected patients with limited disease (T1-2, N0, M0), the high rate of local recurrence after chemoradiotherapy with surgery considered eventually more efficient in the local control of the disease and the fact that surgery is the most accurate tool to access the response to chemotherapy, identify carcinoids misdiagnosed as SCLC and treat the Non Small Cell Lung Cancer component of mixed tumors. Performing surgery for local disease SCLC requires a complete preoperative assessment to exclude the presence of nodal involvement. In stage I surgery must always be followed by adjuvant chemotherapy, while in stage II and III surgery must be planned only in the context of clinical trials and after a pathologic response to induction chemoradiotherapy has been confirmed. Prophylactic cranial irradiation should be used to reduce the incidence of brain metastasis
Highlights
Small cell lung carcinoma represents 15–20% of all lung cancer and it is basically characterized by rapid growth and early metastatic dissemination
Surgery was the treatment of choice for all types of lung cancer but it was abandoned for the subset of Small Cell Lung Cancer (SCLC) almost 30 years ago after the results of the Medical Research Council (UK) randomized trial which compared radiotherapy and surgery in patients with limited disease [2]
In a recent study where EP based regimen was used as adjuvant therapy after complete resection without thoracic or cranial irradiation a 73% 5 year survival was noted in the stage IA subset of patients with an overall of 10% of local recurrence rate [24]
Summary
Small cell lung carcinoma represents 15–20% of all lung cancer and it is basically characterized by rapid growth and early metastatic dissemination. In a recent report by the Imperial College lung resection and mediastinal lymph node dissection used as primary therapy for SCLC either pure (73%) or in mixed histological types was associated with a surprisingly 5 year survival for the total cohort of stage I-III patients of 52% independently of the tumor's T, N and UICC stage [20]. In the era of platinum based chemotherapy as adjuvant treatment in patients with LD-SCLC who underwent surgery Brock et al [23] from Baltimore reported a 58% 5 year survival for stage I disease. In a recent study where EP based regimen was used as adjuvant therapy after complete resection without thoracic or cranial irradiation a 73% 5 year survival was noted in the stage IA subset of patients with an overall of 10% of local recurrence rate [24]. There are three ongoing trials of multimodality treatment including surgery for LD-SCLC: the Essen Thoracic Oncology Trial, the West Japan Thoracic Oncology Group and the German Multicenter Randomized Trial (table 2)
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