Can surgery improve local control in small cell lung cancer?

Current therapy for small cell lung cancer (SCLC) consists of chemotherapy with or without radiotherapy. Radiotherapy is generally accepted as an esse ntial treatment component of limited stage disease. However, the local fail ure rate after chemo- and radiotherapy is still high and ranges from 30-70% . Furthermore, despite having obtained a complete radiographic response, up to 75% of these patients will have residual disease in the tumor specimen, if resection is performed. Therefore, more effective means are needed to e radicate the primary tumor and to obtain an improved local disease control. Recent phase two trials of multimodal regimens for stage I-IIIA SCLC demon strate that in selected patients with early stage SCLC the combination of s urgery and chemotherapy with or without radiotherapy is feasible with low m orbidity and mortality rates. The combination therapy results in satisfying long term outcome depending on the pathological tumor stage and a local di sease control is achieved in almost all patients. It is remarkable that the pneumonectomy rate has decreased over the past decades from almost 100 to 27-39%. In order to confirm these promising results, a German multicenter p rospective randomized phase III trial has been designed for patients with s tage I-IIIA SCLC consisting of induction chemotherapy, followed by surgery, adjuvant thoracic radiotherapy and prophylactic cranial radiation compared to thoracic radiotherapy and prophylactic cranial radiation. (C) 2001 Else vier Science Ireland Ltd. All rights reserved.