The possibility of surgery for small cell lung cancer (state of art)

The author provides information about epidemiology as well as surgical practice for small cell lung cancer (SCLC) in Hungary. It is emphasized that, based on the author's experience and on international consensus, TNM system is the basis of accurate oncological treatment. The oncological management of SCLC is summarized, which is based on surgery. SCLC, especially cases undergoing surgery, are often detected as a peripheral nodule which should be examined preoperatively by special algorithm. Despite the published favorable results, surgical treatment alone is not accepted nowadays as a correct oncological point of view. The aim of adjuvant therapy is to improve survival and to decrease local recurrence. The 5-year survival of SCLC according to stages is between 4 and 60%. After the late 80's, the complex multimodality oncotherapy has started, with neoadjuvant treatment. SCLC is chemosensitive, even at N2 stage after down-staging surgery might be available. The late results show 20-46% cumulative 5-year survival rate. However, in the case of N2 disease, only 15-30% 5-year survival is achieved. This is a critical question for surgery of SCLC, because the dominant opinion is that for N2 disease and especially residual N2 surgery does not prolong survival. SCLC often occurs in combination with NSCLC. Therefore, salvage operation is a possible choice to remove the residual chemo/radiation resistant SCLC and NSCLC components. In conclusion, surgery has an advantage for SCLC therapy especially in patients with stage I-II disease. Value of surgery for stage III/a disease is under discussion and it is not recommended in Hungarian practice. To use a complex neoadjuvant protocol is advised which provides from 20 up to 40% five-year survival rate.