Possibilities of surgery for resectable small cell lung cancer

Kolbanov K.I.; Trakhtenberg A.Kh.; Pikin O.V.

doi:https://doi.org/10.17116/onkolog20176367-75

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Abstract:

The high biological potential of small cell lung cancer (SCLC) has long determined the use of a separate clinical classification and the unjustified surgical treatment of patients. The rate of SCLC does not exceed 20% in the structure of tumors at this site and tends to decrease over the past decades. The possibility and role of surgery in the treatment of this category of patients have been studied intensively over many decades. The paper analyzes more than 60 scientific publications in the period 1980—2016, which cover 6624 operated patients with SCLC. It discusses the peculiarities of surgical treatment and the rate of recurrent SCLC after adjuvant radiation and/or polychemotherapy. The mean 5-year overall survival rate in patients with resectable SCLC is 29.1%. The heterogeneity of patients operated on in both tumor extent and their comorbid status affects the scatter of long-term treatment results (9.0 to 50.0%). There is no agreement among the scientists regarding the high prognostic significance of the stage of the disease, especially the status of the regional lymph nodes. There are the best mean 5-year survival rates in patients with Stage I SCLC (51.7%), satisfactory and lower rates in those with Stages II (31.5%) and IIIA (16.9%) SCLC. The international experience (according to the publications of scientists from the United Kingdom, Belarus, Germany, China, Korea, Norway, Russia, USA, and Japan) with a surgical component of combined treatment in patients with SCLC could formulate quite questionable clinical guidelines on indications for surgery for this morphological type of cancer. The paper identified several advantages of surgical treatment: a) its relatively high long-term results relative to those of medical therapy; b) a possibility of detecting dimorphic tumors, as well as final morphological differential diagnosis with carcinoid; c) estimation the true extent of the process along the lymphatic collector and the degree of therapeutic pathomorphism in the tumor during neoadjuvant therapy; d) a more reliable loco-regional control.

Keywords:

small cell lung cancer

pulmonary neuroendocrine tumors

surgical treatment

standards

clinical guidelines

Authors:

Kolbanov K.I.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ

Trakhtenberg A.Kh.

Moskovskiĭ nauchno-issledovatel'skiĭ onkologicheskiĭ institut im. P.A. Gertsena Rosmedtekhnologiĭ

Pikin O.V.

FGBU "MNIOI im. P.A. Gertsena" Minzdrava Rossii

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