The current role of surgery and SBRT in early stage of small cell lung cancer

Abstract

Background: Early stage small cell lung cancer (T1-2N0M0SCLC) represents 7% of all SCLC. The standard treatment in patients with intrathoracic SCLC disease is the use of concurrent chemoradiotherapy (CRT). Nowadays, the recommended management of this highly selected group is surgical resection due to favorable survival outcomes. For medically inoperable patients or those who refuse surgery, there is an increasing interest in evaluating the role of Stereotactic Body Radiotherapy (SBRT) for T1-2N0SCLC, transferring the favorable experience obtained on inoperable NSCLC (Non-Small-cell Lung Cancer). In the era of multimodality treatment, adjuvant systemic therapy plays an important role even in the management of early SCLC, increasing the disease-free survival (DFS) and Overall Survival (OS). The benefit of Prophylactic Cranial Irradiation (PCI), that currently has a Category I recommendation for localized stage SLCL, remains controversial in this selected subgroup of patients due to the lower risk of brain metastasis.

Aim: This review summarizes the most relevant data on the local management of T1-2N0M0SCLC (surgery and radiotherapy), and evaluates the relevance of adjuvant treatment.

Relevance for patients: Provides a critical evaluation of best current clinical management options for T1-2N0M0 SCLC.

Keywords: chemoradiotherapy; chemotherapy; early stage small cell lung cancer; prophylactic cranial irradiation; radiotherapy; small cell lung cancer; stereotactic ablative radiotherapy; stereotactic body radiotherapy; surgery.

Figure 1. SBRT planning treatment.

Figure 2. Proposed algorithm for treatment of ES-SCLC. SBRT: Stereotactic body radiotherapy; CT: Chemotherapy; RT: Conventional radiotherapy (concomitant or sequential); PCI: Prophylactic cranial irradiation; MRI, Magnetic resonance imaging.