Surgery in Small-Cell Lung Cancer
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Thoracic Surgery, Istituto Nazionale Tumori, “Fondazione G. Pascale”—IRCCS, 80131 Naples, Italy
2
Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
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Pathology, Istituto Nazionale Tumori, “Fondazione G. Pascale”–IRCCS, 80131 Naples, Italy
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Scientific Directorate, Istituto Nazionale Tumori, “Fondazione G. Pascale”–IRCCS, 80131 Naples, Italy
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Radiotherapy, Istituto Nazionale Tumori “Fondazione G. Pascale”–IRCCS, 80131 Naples, Italy
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Radiology, Istituto Nazionale Tumori, “Fondazione G. Pascale”–IRCCS, 80131 Naples, Italy
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Cellular Biology and Biotherapy, Istituto Nazionale Tumori, “Fondazione G. Pascale”—IRCCS, 80131 Naples, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: David Wong
Cancers 2021, 13(3), 390; https://doi.org/10.3390/cancers13030390
Received: 23 December 2020
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Revised: 12 January 2021
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Accepted: 18 January 2021
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Published: 21 January 2021
(This article belongs to the Special Issue Small Cell Lung Cancer: A New Era Is Beginning?)
Simple Summary
Small-cell lung cancer (SCLC) accounts for approximately 15% of all lung cancers and is one of the most aggressive tumors, with poor prognosis and limited therapeutic options. This review summarizes the main results observed with surgery in SCLC, discussing the critical issues related to the use of this approach. Following two old randomized clinical trials showing no benefit with surgery, several prospective, retrospective, and population-based studies have demonstrated the feasibility of a multimodality approach including surgery in addition to chemotherapy and radiotherapy in patients with selected stage I SCLC. Currently, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging within a multimodal approach and after a multidisciplinary evaluation.
Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36–63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.
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Keywords:
small-cell lung cancer; lobectomy; pneumonectomy; radiotherapy; chemotherapy; multimodal treatment
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
MDPI and ACS Style
Martucci, N.; Morabito, A.; La Rocca, A.; De Luca, G.; De Cecio, R.; Botti, G.; Totaro, G.; Muto, P.; Picone, C.; Esposito, G.; Normanno, N.; La Manna, C. Surgery in Small-Cell Lung Cancer. Cancers 2021, 13, 390. https://doi.org/10.3390/cancers13030390
AMA Style
Martucci N, Morabito A, La Rocca A, De Luca G, De Cecio R, Botti G, Totaro G, Muto P, Picone C, Esposito G, Normanno N, La Manna C. Surgery in Small-Cell Lung Cancer. Cancers. 2021; 13(3):390. https://doi.org/10.3390/cancers13030390
Chicago/Turabian StyleMartucci, Nicola, Alessandro Morabito, Antonello La Rocca, Giuseppe De Luca, Rossella De Cecio, Gerardo Botti, Giuseppe Totaro, Paolo Muto, Carmine Picone, Giovanna Esposito, Nicola Normanno, and Carmine La Manna. 2021. "Surgery in Small-Cell Lung Cancer" Cancers 13, no. 3: 390. https://doi.org/10.3390/cancers13030390
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