[Small-cell lung tumors: is a more accurate staging possible and useful?]

Small cell lung cancer is generally staged as a localized or diffuse disease due to its great invasiveness and quick spread. The authors investigated the advantages of a more accurate staging by TNM system applied to small cell lung cancer. Sixteen patients (12 males and 4 females, mean age 54 years, max 66, min 48) were submitted to a treatment protocol consisting of 6 cycles of chemotherapy over an 18-month period. All patients underwent CT before and after the third and sixth cycles. Disease evolution was evaluated by means of the TNM system; relative to the N parameter, the American Thoracic Society criteria were followed. After completion of the third chemotherapy cycle, CT demonstrated reduction in T in 7/16 cases, while in the extant patients T was unchanged. N decreased too in 7 patients and remained unchanged in the others. CT examinations at the end of the whole treatment protocol demonstrated no changes in T. As for N, CT showed evolution from N0 to N2 in one case and from N3 to N0 in another one, while no changes were observed in the extant patients. The M parameter was constantly negative in all cases. Our results demonstrate that this approach to small cell lung cancer permits a more accurate characterization of the disease, thus making it easier to monitor the positive/negative response to treatment and allowing the latter to be personalized.