Comparing Treatment Strategies for Stage I Small-cell lung Cancer

The diagnosis of stage I small-cell lung cancer (SCLC) is increasing in incidence with the advent of low-dose screening computed tomography. Surgery is considered the standard of care but there are very few data to guide clinical decision-making. The purpose of this study was to compare outcomes for patients receiving definitive surgery, stereotactic body radiation therapy (SBRT), or external beam radiation therapy (EBRT) for stage I SCLC.

Patients with a primary diagnosis of stage I SCLC were identified in the National Cancer Database. Patients were defined as having a first course of treatment of either surgery, EBRT, or SBRT. Overall survival (OS) was determined using the Kaplan-Meier method and Cox proportional hazards regression methods were used to estimate risk of overall mortality.

A total of 2678 patients were included in the analysis. The 2- and 3-year OS for the whole cohort was 62% and 50%. Comparing treatment strategies in a multivariate model, surgical resection showed improved OS over EBRT (P < .001) and SBRT (P < .001), however, the OS benefit over SBRT did not persist for patients who underwent limited resection. When excluding patients who underwent surgery, SBRT showed improved OS compared with EBRT (P = .04). Additional use of chemotherapy with any treatment modality resulted in improved OS (P < .001).

In this hospital-based registry study, definitive surgical resection and use of chemotherapy resulted in improved survival for patients with early stage SCLC. For patients who are not candidates for surgery, SBRT may offer a survival benefit compared with standard EBRT.