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Surgery in Small-Cell Lung Cancer

2021; Multidisciplinary Digital Publishing Institute; Volume: 13; Issue: 3 Linguagem: Inglês

10.3390/cancers13030390

2072-6694

Nicola Martucci, Alessandro Morabito, Antonello La Rocca, Giuseppe De Luca, Rossella De Cecio, Gerardo Botti, Giuseppe Totaro, Paolo Muto, Carmine Picone, Giovanna Esposito, Nicola Normanno, Carmine La Manna,

Gestational Trophoblastic Disease Studies

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.