Surgery in Small-Cell Lung Cancer

Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies con...

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Bibliographic Details
Published in:Cancers 2021-01, Vol.13 (3), p.390
Main Authors: Martucci, Nicola, Morabito, Alessandro, La Rocca, Antonello, De Luca, Giuseppe, De Cecio, Rossella, Botti, Gerardo, Totaro, Giuseppe, Muto, Paolo, Picone, Carmine, Esposito, Giovanna, Normanno, Nicola, La Manna, Carmine
Format: Article
Language:English
Subjects:
Brain research
Cancer therapies
Chemotherapy
Disease
Feasibility studies
Lung cancer
Medical prognosis
Metastases
Metastasis
Ostomy
Patients
Population studies
Radiation therapy
Review
Small cell lung carcinoma
Surgery
Thorax
Tumors
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Summary:Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36-63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers13030390