Surgery and Stereotactic Radiotherapy for Stage I Small-Cell Lung Carcinoma: A 25-Year Experience

Area of Science:

• Oncology
• Thoracic Surgery
• Radiation Oncology

Background:

• Small-cell lung cancer (SCLC) is typically aggressive but can present as localized, treatable disease.
• Limited-stage SCLC offers an opportunity for local therapeutic interventions.

Purpose of the Study:

• To evaluate the safety and efficacy of surgery versus stereotactic body radiotherapy (SBRT) for clinical stage I SCLC.
• To compare survival rates and treatment toxicity between surgical resection and SBRT in this patient cohort.

Main Methods:

• Retrospective review of clinical stage I lymph node-negative SCLC patients treated with surgery or SBRT (1996-2021).
• Analysis included patient demographics, pulmonary function, comorbidities, tumor histology, and survival outcomes.
• Multivariable Cox Proportional Hazards model was utilized for survival analysis.

Main Results:

• 96 patients were included: 77 surgical, 19 SBRT. Surgical patients were younger with better pulmonary function; SBRT patients had more comorbidities.
• Median survival was 31 months for surgery vs. 21 months for SBRT (P=0.07). No treatment-related mortalities.
• Node-negative surgery patients showed significantly longer survival (median 48 months) with 2- and 5-year survival rates of 60% and 48%.

Conclusions:

• Surgery and SBRT are safe and effective local treatments for clinical stage I SCLC.
• Survival outcomes, while lower than non-small-cell lung cancer, compare favorably to historical SCLC treatments.
• These findings support the use of surgery or SBRT for select stage I SCLC patients.