title: When is surgery indicated for small-cell lung cancer?
abstract: Small-cell lung cancer (SCLC) comprises 13-20% of all lung cancers but is the fifth leading cause of cancer death worldwide. SCLC prognosis remains poor despite improvements in diagnosis and therapy over the last 30 years. Current treatment is systemic chemotherapy, flanked by thoracic irradiation for limited stage disease; however, about two-thirds of patients are diagnosed with extensive stage disease when thoracic irradiation is not worthwhile. Randomized trials on surgical resection in patients with limited stage disease conducted in the pre-PET era, when both staging and treatment were inadequate, did not support a role for surgery in disease management. However recent retrospective and population-based studies indicate that outcomes after surgery in patients with very early SCLC are comparable to those in patients with non-SCLC, and that survival is better than in SCLC patients not given surgery. CT screening identifies SCLC at an earlier stage - with better survival - than usual care, and offers the hope that more SCLC patients may become long-term survivors. However, cases must be exhaustively staged to identify those likely to benefit from surgery. Finding a specific SCLC marker to facilitate early diagnosis remains a priority.
authors.affiliation: Division of Thoracic and General Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Italy. Electronic address: Giulia.veronesi@humanitas.it.
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: Division of Thoracic and General Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Bottoni
authors.affiliation: Department of Medical Oncology, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Finocchiaro
authors.affiliation: Division of Thoracic and General Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Alloisio
mesh_terms: D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D011159:Population Surveillance; D011379:Prognosis; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery; D016896:Treatment Outcome
keywords: Early detection; Limited disease; Radiotherapy; Small cell lung cancer; Surgery; TNM