Selective surgical resection in the management of small-cell carcinoma of the lung

There is increasing evidence that selected patients with small-cell carcinoma of the lung (SCCL) may benefit from surgical resection. Since 1983, sixteen patients (aged 40-72 years) with limited SCCL underwent surgical resection before any other treatment. Criteria for patient selection were the following: 1) no pre-operative histological diagnosis or 2) pre-operative diagnosis of T1 or T2 SCCL, without evidence of both distant and mediastinal node metastases. All patients had potentially, curative resection (lobectomy: 11 cases; pneumonectomy: 5 cases). Postoperatively patients were classified as stage I in 7 cases, as stage II in 3 cases and as stage III in 6 cases. All subjects but one subsequently received adjuvant chemotherapy (Cisplatin; Adriamycin; VP-16). Prophylactic cranial irradiation was not given. Median survival time was 15.2 months for the whole group of patients, 19.6 months for stage I patients, 16 months for stage II patients and 9.7 months for stage III patients. The 2-year survival rate was 32% for all cases, 63% for stage I cases and 0% for stage II and stage III cases. Three stage I patients are alive and disease-free, 24, 26 and 31 months after resection, respectively. The brain was the most common site of initial relapse in stage I cases. These results suggest that surgery might favor intrathoracic disease control exclusively in stage I and stage II patients. Resection seems to be contraindicated in N2 tumors. If treatment policy is to achieve total disease control, prophylactic cranial irradiation should be recommended, notably in patients with stage I SCCL.(ABSTRACT TRUNCATED AT 250 WORDS)