Small cell carcinoma of the lung surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2] Dildar Hussain, MBBS [3]

Overview

The feasibility of surgery depends on the stage of small cell lung carcinoma at diagnosis. In small cell lung carcinoma, surgery should only be considered among patients with clinical stage I (T1-2, N0). Postoperative chemotherapy with or without radiation therapy is recommended based on the presence or absence of lymph node involvement.

Surgery

  • The feasibility of surgery depends on the stage of small cell lung carcinoma at diagnosis.[1]
  • Surgery should only be considered among patients with clinical stage I (T1-2, N0). Given that the majority of patients are not diagnosed with clinical stage I (T1-2,N0), surgery is rarely performed among SCCL patients.[1][2]
  • Before a patient is considered for surgical resection of the tumor, investigation for occult nodal involvement by either mediastinoscopy or mediastinal node dissection should be performed.
  • Post-operative palliative treatment following surgery includes:[1]
    • Chemotherapy if there is no nodal involvement
    • Chemotherapy PLUS radiation therapy if there is nodal involvement
    • Prophylactic cranial irradiation is recommended among patients who undergo complete resection of the tumor,[3] as long as their performance status is good and they do not have any neurological cognitive impairment.

References

  1. 1.0 1.1 1.2 Jackman, David M; Johnson, Bruce E (2005). "Small-cell lung cancer". The Lancet. 366 (9494): 1385–1396. ISSN 0140-6736. doi:10.1016/S0140-6736(05)67569-1. 
  2. NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
  3. Aupérin A, Arriagada R, Pignon JP, Le Péchoux C, Gregor A, Stephens RJ; et al. (1999). "Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group.". N Engl J Med. 341 (7): 476–84. PMID 10441603. doi:10.1056/NEJM199908123410703. 

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