Updated January 2014

If SCLC is identified unexpectedly at the time of thoracotomy, complete resection and mediastinal lymph node biopsies should be taken if possible. There may be a role for surgery in highly selected cases of SCLC who have "very limited" (stage I and II) disease. These patients should have careful preoperative staging including a PET scan and mediastinal lymph node evaluation (mediastinoscopy/EBUS). Adjuvant combination chemotherapy should be given when they have recovered sufficiently from surgery (four cycles of a platinum plus etoposide Protocol LUSCPE).

Down-staging of limited SCLC with mediastinal lymph node involvement with neoadjuvant chemotherapy followed by radiotherapy and surgical resection has been assessed in a randomized trial performed by the Lung Cancer Study Group. The results were poor and the treatment was toxic. Such therapy is not recommended.

References:

1. Shepherd FA. Surgical management of small cell lung cancer. In, Lung Cancer: Principles and Practice, Pass HI, Mitchell JB, Johnson D, Turrisi A. Lippincott-Raven Publishers, Philadelphia, 1996, pp899.

2. Lad T, Thomas P, Piantadosi S. et al. A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy. Chest 1994;106(6 Suppl):320S-323S.