Role of surgery in multimodality therapy for small cell lung cancer
- Eric Vallières, MD, FRCSC
Eric Vallières, MD, FRCSC
- Surgical Director of the Lung Cancer Program
- Swedish Cancer Institute
- Section Editors
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
Small cell lung cancer (SCLC) is distinct from non-small cell carcinoma (NSCLC) both biologically and clinically. SCLC comprises approximately 15 percent of all lung cancers. It occurs almost exclusively in cigarette smokers; in one series, only 2 percent of 500 patients with SCLC did not have a smoking history . SCLC is also the most common histologic subtype among uranium miners, probably due to exposure to radioactive radon, which is a byproduct of uranium decay . (See "Pathobiology and staging of small cell carcinoma of the lung".)
SCLC is distinguished from NSCLC by its rapid growth characteristics and the early development of widespread metastases. SCLC is highly responsive to chemotherapy, while there is a substantial historical experience documenting the futility of surgery and/or radiation therapy (RT) without systemic chemotherapy. Prior to the introduction of systemic chemotherapy, median survivals for patients with limited stage (LS) disease (limited to the ipsilateral hemithorax and regional lymph nodes) and extensive stage (ES) disease were approximately 12 weeks and 5 weeks, respectively . Many studies have demonstrated that chemotherapy significantly improves survival when compared with surgery or RT alone, and combination chemotherapy is the mainstay of therapy for both LS and ES SCLC. (See "Pathobiology and staging of small cell carcinoma of the lung", section on 'Staging'.)
Although the combination of chemotherapy plus radiation improves survival in patients with LS-SCLC, local recurrence rates in patients undergoing chemoradiotherapy are between 35 and 50 percent . This high local failure rate has led to reconsideration of the role of surgery as a way to improve rates of local control.
OVERVIEW OF TREATMENT OF LS-SCLC
Patients with SCLC are often staged as those with LS disease (limited to the ipsilateral hemithorax and regional lymph nodes) and those with more extensive stage (ES) disease. Most patients with LS-SCLC will have clinical or pathologic evidence of mediastinal lymph node disease. Careful staging, including invasive staging of the mediastinum and MRI of the brain, is indicated to identify the small fraction of patients with LC-SCLC who do not have mediastinal or metastatic disease. (See "Pathobiology and staging of small cell carcinoma of the lung", section on 'Staging'.)
●For patients with LS-SCLC who have clinical or pathologic evidence of mediastinal disease, chemoradiotherapy is indicated as the initial treatment. (See "Limited stage small cell lung cancer: Initial management", section on 'Benefit of treatment'.)
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- OVERVIEW OF TREATMENT OF LS-SCLC
- SURGERY ALONE FOR LS-SCLC
- SURGERY IN MULTIMODALITY TREATMENT FOR LS-SCLC
- Surgery as initial therapy
- - Postoperative chemotherapy
- - Postoperative radiation therapy
- - Prophylactic cranial irradiation
- Surgery after induction chemotherapy
- INFORMATION FOR PATIENTS