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.
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.
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.