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According to the results of a study conducted in Italy, certain subsets of patients with small cell lung cancer (SCLC) may benefit from undergoing surgery after chemotherapy. These results were published in the Journal of Thoracic Oncology.

Small cell lung cancers account for 20–25% of all lung cancers and are primarily diagnosed in smokers or former smokers. They differ from other types of lung cancer in that they spread very quickly throughout the body via the blood and lymphatic system.

Accurate staging of small cell lung cancer is essential before definitive therapy can begin. A simple staging system is often used to separate small cell lung cancer into two stages, referred to as limited and extensive.

If staging tests reveal no evidence of your cancer having spread outside a well-defined area in your lungs, then you will be diagnosed with limited stage small cell lung cancer. Otherwise, you will be diagnosed with extensive disease. However, it is important to understand that nearly all patients with small cell lung cancer already have cancer that has spread outside the chest but cannot be detected with currently available diagnostic tests.

Because SCLC has typically spread throughout the body at the time of diagnosis, surgery generally has a very minor role in the treatment of SCLC. Nevertheless, researchers continue to explore whether certain patient subsets may benefit from surgery.

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Recently, researchers in Italy described treatment outcomes among 23 patients with operable SCLC. Before surgery, patients received chemotherapy with carboplatin plus etoposide with or without ifosfamide. Some patients also received radiation therapy.

  • 22% of patients experienced a complete disappearance of detectable cancer following chemotherapy, and 64% of patients experienced a partial disappearance of detectable cancer.
  • 19 of the 23 study participants underwent surgery with the intent to cure the cancer.
  • Two patients died of surgery-related complications.
  • Overall, 49% of patients survived for at least two years and 25% of patients survived for at least three years. Among patients with no evidence of cancer in lymph nodes or other areas outside the lung, two-year survival was 91%.
  • 52% of patients eventually experienced a cancer recurrence. Patients with no evidence of cancer in the lymph nodes or other areas outside the lung had a lower risk of recurrence than other patients.

The researchers conclude that certain patients with very limited, operable SCLC may benefit from surgery after chemotherapy.

Reference: Veronesi G, Scanagutta P, Leo F et al. Adjuvant surgery after carboplatin and VP16 in resectable small cell lung cancer. Journal of Thoracic Oncology. 2007;2:131-134.

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