Stereotactic body radiotherapy with concurrent chemotherapy extends survival of patients with limited stage small cell lung cancer: a single-center prospective phase II study Clinical results of stereotactic body radiotherapy for Stage I small-cell lung cancer: a single institutional experience Surgery for cure followed by chemotherapy in small cell carcinoma of the lung. For the ISC-Lung Cancer Study Group. Protocol for the CONVERT trial—Concurrent ONce-daily VErsus twice-daily RadioTherapy: an international 2-arm randomised controlled trial of concurrent chemoradiotherapy comparing twice-daily and once-daily radiotherapy schedules in patients with limited stage small cell lung cancer (LS-SCLC) and goo Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial Outcomes of Stereotactic Body Radiotherapy for T1‐T2N0 Small Cell Carcinoma According to Addition of Chemotherapy and Prophylactic Cranial Irradiation: A Multicenter Analysis Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer--evidence from a phase II trial. Omission of elective node irradiation on basis of CT-scans in patients with limited disease small cell lung cancer: a phase II trial. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy. Phase II trial of postoperative adjuvant cisplatin and etoposide in patients with completely resected stage I-IIIa small cell lung cancer: the Japan Clinical Oncology Lung Cancer Study Group Trial (JCOG9101). Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus. Ten-year follow-up. Long term results of surgery and chemotherapy in small cell lung cancer. Surgery Plus Adjuvant Chemotherapy for T1–3N0M0 Small‐Cell Lung Cancer: Rationale for Current Approach
We carried out a prospect i ve phase II study of patients with limited stage small cell lung cancer ( LS-SCLC ) assigned to receive stereotactic body radiotherapy ( SBRT ) concurrently with cisplatin-based chemotherapeutic regimen with OS and PFS as the primary study endpoints . Patients with pathologically proven LS-SCLC received 4–6 cycles of cisplatin 75 mg/(m2/day ) given intravenously on day 1 and etoposide 80 mg/(m2/day ) given intravenously on days 1–5 , both at 3 weekly intervals . SBRT at a dose of 4,000–4,500 cGy in ten fractions was given concurrently with chemotherapy starting on day 1 . The Kaplan – Meier curve and life tables were used to describe survival data . Adverse events were evaluated according to the common terminology criteria for adverse events version of the radiation therapy oncology group ( RTOG ) . Twenty-nine patients were included and followed up for a median duration of 19 ( range 10–85 ) months . The median OS was 27 ( 95 % CI 20.2–33.8 ) months . The median PFS was 12 ( 95 % CI 4.2–19.8 ) months . No grade 4 adverse events were observed . Grade 3 adverse events occurred in only 5 ( 13.8 % , 5/29 ) patients . Neutropenia of any grade was observed in 6 ( 15 % , 6/29 ) patients , with grade 3 neutropenia only seen in one ( 3.4 % , 1/29 ) patient . The combination of chemotherapy and early concurrent SBRT could be a safe and effective treatment for LS-SCLC patients . Our study confirmed that SBRT with concurrent chemotherapy is another new treatment option for LS-SCLC patients The purpose of this study was to evaluate the treatment outcomes of stereotactic body radiotherapy ( SBRT ) for Stage I small-cell lung cancer ( SCLC ) . From April 2003 to September 2009 , a total of eight patients with Stage I SCLC were treated with SBRT in our institution . In all patients , the lung tumors were proven as SCLC pathologically . The patients ' ages were 58–84 years ( median : 74 ) . The T-stage of the primary tumor was T1a in two , T1b in two and T2a in four patients . Six of the patients were inoperable because of poor cardiac and /or pulmonary function , and two patients refused surgery . SBRT was given using 7–8 non-coplanar beams with 48 Gy in four fractions . Six of the eight patients received 3–4 cycles of chemotherapy using carboplatin ( CBDCA ) + etoposide ( VP-16 ) or cisplatin ( CDDP ) + irinotecan ( CPT-11 ) . The follow-up period for all patients was 6–60 months ( median : 32 ) . Six patients were still alive without any recurrence . One patient died from this disease and one died from another disease . The overall and disease-specific survival rate at three years was 72 % and 86 % , respectively . There were no patients with local progression of the lesion targeted by SBRT . Only one patient had nodal recurrence in the mediastinum at 12 months after treatment . The progression-free survival rate was 71 % . No Grade 2 or higher SBRT-related toxicities were observed . SBRT plus chemotherapy could be an alternative to surgery with chemotherapy for inoperable patients with Stage I small-cell lung cancer . However , further investigation is needed using a large series of patients The Lung Cancer Study Group of the International Society of Chemotherapy ( ISC-LCSG ) organized multinational , cooperative , prospect i ve and r and omized trials for the cure of patients with small cell lung cancer at early stages ( T1,2N0M0 ) . Surgery for cure was used first , followed by postoperative chemotherapy , and thereafter by prophylactic cranial irradiation . Eight cycles of st and ard chemotherapy ( CAV-cyclophosphamide-doxorubicin-vincristine ) or 6 intermittent cycles of alternating chemotherapy , using 3 different drug combinations , were administered 1 - 2 weeks postoperatively for 6 months after r and omization . A total of 183 evaluable patients received surgery for cure at 23 cooperating hospitals . The preliminary evaluation of ISC- studies I and II per May 1993 result ed in the 30-month total survival of 63 % from 68 patients after complete resection at TN0M0R0-stages and 37 % from 27 patients after such resections at TN2M0R0-stages . Their incidence of local recurrence as first relapse was quite similar ( 11/47:8/39 ) . The related 4-year recurrence-free survival ( 57 % , 37 % ) , indicating a plateau-like curve of long-term survivors . These promising results have to be confirmed by larger studies . We conclude that the indication for surgery as the first treatment step for SCLC should be the same as for the other non-small subtypes of lung cancers Introduction Concurrent ONce-daily VErsus twice-daily RadioTherapy ( CONVERT ) is the only multicentre , international , r and omised , phase III trial open in Europe and Canada looking at optimisation of chemoradiotherapy ( RT ) in limited stage small cell lung cancer ( LS-SCLC ) . Following on from the Turrisi trial of once-daily versus twice-daily ( BD ) concurrent chemoradiotherapy , there is a real need for a new phase III trial using modern conformal RT techniques and investigating higher once-daily radiation dose . This trial has the potential to define a new st and ard chemo-RT regimen for patients with LS-SCLC and good performance status . Methods and analysis 447 patients with histologically or cytologically proven diagnosis of SCLC were recruited from 74 centres in eight countries between 2008 and 2013 . Patients were r and omised to receive either concurrent twice-daily RT(45 Gy in 30 twice-daily fractions over 3 weeks ) or concurrent once-daily RT(66 Gy in 33 once-daily fractions over 6.5 weeks ) both starting on day 22 of cycle 1 . Patients are followed up until death . The primary end point of the study is overall survival and secondary end points include local progression-free survival , metastasis-free survival , acute and late toxicity based on the Common Terminology Criteria for Adverse Events V.3.0 , chemotherapy and RTdose intensity . Ethics and dissemination The trial received ethical approval from NRES Committee North West — Greater Manchester Central ( 07/H1008/229 ) . There is a trial steering committee , including independent members and an independent data monitoring committee . Results will be published in a peer- review ed journal and presented at international conferences . Trial registration number IS RCT N91927162 ; Pre- results Summary Background Concurrent chemoradiotherapy is the st and ard of care in limited-stage small-cell lung cancer , but the optimal radiotherapy schedule and dose remains controversial . The aim of this study was to establish a st and ard chemoradiotherapy treatment regimen in limited-stage small-cell lung cancer . Methods The CONVERT trial was an open-label , phase 3 , r and omised superiority trial . We enrolled adult patients ( aged ≥18 years ) who had cytologically or histologically confirmed limited-stage small-cell lung cancer , Eastern Cooperative Oncology Group performance status of 0–2 , and adequate pulmonary function . Patients were recruited from 73 centres in eight countries . Patients were r and omly assigned to receive either 45 Gy radiotherapy in 30 twice-daily fractions of 1·5 Gy over 19 days , or 66 Gy in 33 once-daily fractions of 2 Gy over 45 days , starting on day 22 after commencing cisplatin – etoposide chemotherapy ( given as four to six cycles every 3 weeks in both groups ) . The allocation method used was minimisation with a r and om element , stratified by institution , planned number of chemotherapy cycles , and performance status . Treatment group assignments were not masked . The primary endpoint was overall survival , defined as time from r and omisation until death from any cause , analysed by modified intention-to-treat . A 12 % higher overall survival at 2 years in the once-daily group versus the twice-daily group was considered to be clinical ly significant to show superiority of the once-daily regimen . The study is registered with Clinical Trials.gov ( NCT00433563 ) and is currently in follow-up . Findings Between April 7 , 2008 , and Nov 29 , 2013 , 547 patients were enrolled and r and omly assigned to receive twice-daily concurrent chemoradiotherapy ( 274 patients ) or once-daily concurrent chemoradiotherapy ( 273 patients ) . Four patients ( one in the twice-daily group and three in the once-daily group ) did not return their case report forms and were lost to follow-up ; these patients were not included in our analyses . At a median follow-up of 45 months ( IQR 35–58 ) , median overall survival was 30 months ( 95 % CI 24–34 ) in the twice-daily group versus 25 months ( 21–31 ) in the once-daily group ( hazard ratio for death in the once daily group 1·18 [ 95 % CI 0·95–1·45 ] ; p=0·14 ) . 2-year overall survival was 56 % ( 95 % CI 50–62 ) in the twice-daily group and 51 % ( 45–57 ) in the once-daily group ( absolute difference between the treatment groups 5·3 % [ 95 % CI −3·2 % to 13·7 % ] ) . The most common grade 3–4 adverse event in patients evaluated for chemotherapy toxicity was neutropenia ( 197 [ 74 % ] of 266 patients in the twice-daily group vs 170 [ 65 % ] of 263 in the once-daily group ) . Most toxicities were similar between the groups , except there was significantly more grade 4 neutropenia with twice-daily radiotherapy ( 129 [ 49 % ] vs 101 [ 38 % ] ; p=0·05 ) . In patients assessed for radiotherapy toxicity , was no difference in grade 3–4 oesophagitis between the groups ( 47 [ 19 % ] of 254 patients in the twice-daily group vs 47 [ 19 % ] of 246 in the once-daily group ; p=0·85 ) and grade 3–4 radiation pneumonitis ( 4 [ 3 % ] of 254 vs 4 [ 2 % ] of 246 ; p=0·70 ) . 11 patients died from treatment-related causes ( three in the twice-daily group and eight in the once-daily group ) . Interpretation Survival outcomes did not differ between twice-daily and once-daily concurrent chemoradiotherapy in patients with limited-stage small-cell lung cancer , and toxicity was similar and lower than expected with both regimens . Since the trial was design ed to show superiority of once-daily radiotherapy and was not powered to show equivalence , the implication is that twice-daily radiotherapy should continue to be considered the st and ard of care in this setting . Funding Cancer Research UK ( Clinical Trials Awards and Advisory Committee ) , French Ministry of Health , Canadian Cancer Society Research Institute , European Organisation for Research and Treatment of Cancer ( Cancer Research Fund , Lung Cancer , and Radiation Oncology Groups ) Background Although T1‐T2N0 non – small cell lung cancer can be managed with stereotactic body radiotherapy ( SBRT ) alone , this management has often been extrapolated to T1‐T2N0 small cell lung cancer ( SCLC ) . This secondary analysis of a multi‐institutional cohort study investigated whether the addition of chemotherapy and prophylactic cranial irradiation ( PCI ) improved the outcomes for these patients . Material s and Methods All cases of histologically confirmed T1‐T2N0M0 SCLC were obtained from 24 institutions ' prospect ively collected SBRT data bases . The clinical and treatment characteristics , toxicities , outcomes , and patterns of failure were assessed . We used Kaplan‐Meier analysis to evaluate the survival outcomes . Univariate and multivariate analyses identified the predictors of outcomes . Results From 24 institutions , 76 lesions were treated in 74 patients ( median follow‐up , 18 months ) . Chemotherapy and PCI were delivered in 56 % and 23 % of cases , respectively . The median SBRT dose per fraction was 50 Gy/5 fractions . Patients receiving chemotherapy experienced increased median disease‐free survival ( 61.3 vs. 9.0 months ; P = .02 ) and overall survival ( 31.4 vs. 14.3 months ; P = .02 ) . Chemotherapy independently predicted for better outcomes for disease‐free survival and overall survival on multivariate analysis ( P = .01 ) . Toxicities were uncommon ; 5.2 % experienced grade ≥ 2 pneumonitis . Post‐treatment failures were most commonly distant ( 45.8 % of recurrences ) , followed by nodal ( 25.0 % ) , and elsewhere in the lung ( 20.8 % ) . The median time to each was 5 to 7 months . Conclusion Patients undergoing primary SBRT for T1‐T2N0 SCLC should also undergo additional chemotherapy . No established role was found for PCI in this population . Micro‐ Abstract T1‐T2N0 small cell lung cancer ( SCLC ) is rare but is often treated with stereotactic body radiotherapy alone , similar to the treatment of T1‐T2N0 non‐SCLC . This secondary analysis of a multicenter study assessed whether additional chemotherapy or prophylactic cranial irradiation improves the outcomes . Chemotherapy improved disease‐free survival . The use of prophylactic cranial irradiation was not significantly associated statistically with outcomes . These results suggest that T1‐T2N0 SCLC should be treated as limited‐stage SCLC with no clear indication for prophylactic cranial irradiation Omitting elective nodal irradiation ( ENI ) in limited-stage disease small cell lung cancer ( LD-SCLC ) is expected to result in smaller radiation fields . We report on data from a r and omised phase II trial that omitted ENI in patients receiving concurrent chemo-radiotherapy for LD-SCLC . 38 patients with LD-SCLC were r and omised to receive once-daily ( 66 Gy in 33 fractions ) or twice-daily ( 45 Gy in 30 fractions ) radiotherapy ( RT ) . 3D-conformal RT was given concurrently with cisplatin and etoposide starting with the second cycle of a total of four cycles . The gross tumour volume was defined as primary tumour with involved lymph nodes ( nodes ≥1 cm in short axis ) identifiable with CT imaging . ENI was not used . Six recurrence patterns were identified : recurrence within planning target volume ( PTV ) only , recurrence within PTV+regional nodal recurrence and /or distant recurrence , isolated nodal recurrence outside PTV , nodal recurrence outside PTV+distant recurrence , distant metastases only and no recurrence . At median follow-up 16.9 months , 31/38 patients were evaluable and 14/31 patients had relapsed . There were no isolated nodal recurrences . Eight patients relapsed with intra-thoracic disease : 2 within PTV only , 4 within PTV and distantly and 2 with nodal recurrence outside PTV plus distant metastases . Rates of grade 3 + acute oesophagitis and pneumonitis in the 31 evaluable patients were 23 and 3 % respectively . In our study of LD-SCLC , omitting ENI based on CT imaging was not associated with a high risk of isolated nodal recurrence , although further prospect i ve studies are needed to confirm this . Routine ENI omission will be further evaluated prospect ively in the ongoing phase III CONVERT trial ( NCT00433563 ) PURPOSE To evaluate the patterns of recurrence when elective node irradiation was omitted in patients with limited disease small cell lung cancer ( LD-SCLC ) . METHODS A prospect i ve phase II study was undertaken in 27 patients with LD-SCLC without detectable distant metastases on CT scan .  Chest radiotherapy to a dose of 45 Gy in 30 fractions in 3 weeks ( 1.5 Gy BID with 6 - 8 h interval ) was delivered concurrently with carboplatin and etoposide chemotherapy . Chest radiation started after a mean time of 17.7 days + /- 9.7 days ( SD ) ( range : 0 - 33 days ) after the beginning of chemotherapy . Only the primary tumour and the positive nodal areas on the pre-treatment CT scan were irradiated . A total of five chemotherapy cycles were administered , followed by prophylactic cranial irradiation ( PCI ) in patients without disease progression . Isolated nodal failure was defined as recurrence in the regional nodes outside of the clinical target volume , in the absence of in-field failure . RESULTS After a median time of 18 months post-radiotherapy , 7 patients ( 26 % , 95 % CI 19.5 - 42.5 % ) developed a local recurrence . Three patients ( crude rate 11 % , 95 % CI 2.4 - 29 % ) , developed an isolated nodal failure , all of them in the ipsilateral supraclavicular fossa . The median actuarial overall survival was 21 months ( 95 % CI 15.3 - 26.7 ) , and the median actuarial progression free survival was 16 months ( 95 % CI 6.5 - 25.5 ) . Eight patients developed an acute , reversible grade 3 ( CTC 3.0 ) radiation oesophagitis ( 30 % , 95 % CI 14 - 50 % ) . CONCLUSIONS Because of the small sample size , no definitive conclusions can be drawn . However , the omission of elective nodal irradiation on the basis of CT scans in patients with LD-SCLC result ed in a higher than expected rate of isolated nodal failures in the ipsilateral supraclavicular fossa . The incidence of acute , reversible oesophagitis was in the same range as reported with elective nodal fields . The safety of selective nodal irradiation in NSCLC should not be extrapolated to patients with LD-SCLC until more data are available . In the mean time , elective nodal irradiation should only be omitted in clinical trials BACKGROUND For small-cell lung cancer confined to one hemithorax ( limited small-cell lung cancer ) , thoracic radiotherapy improves survival , but the best ways of integrating chemotherapy and thoracic radiotherapy remain unsettled . Twice-daily accelerated thoracic radiotherapy has potential advantages over once-daily radiotherapy . METHODS We studied 417 patients with limited small-cell lung cancer . All the patients received four 21-day cycles of cisplatin plus etoposide . We r and omly assigned these patients to receive a total of 45 Gy of concurrent thoracic radiotherapy , given either twice daily over a three-week period or once daily over a period of five weeks . RESULTS Twice-daily treatment beginning with the first cycle of chemotherapy significantly improved survival as compared with concurrent once-daily radiotherapy ( P=0.04 by the log-rank test ) . After a median follow-up of almost 8 years , the median survival was 19 months for the once-daily group and 23 months for the twice-daily group . The survival rates for patients receiving once-daily radiotherapy were 41 percent at two years and 16 percent at five years . For patients receiving twice-daily radiotherapy , the survival rates were 47 percent at two years and 26 percent at five years . Grade 3 esophagitis was significantly more frequent with twice-daily thoracic radiotherapy , occurring in 27 percent of patients , as compared with 11 percent in the once-daily group ( P<0.001 ) . CONCLUSIONS Four cycles of cisplatin plus etoposide and a course of radiotherapy ( 45 Gy , given either once or twice daily ) beginning with cycle 1 of the chemotherapy result ed in overall two- and five-year survival rates of 44 percent and 23 percent , a considerable improvement in survival rates over previous results in patients with limited small-cell lung cancer Three hundred twenty-eight patients with limited stage small cell lung cancer were enrolled in a trial to evaluate surgical treatment for such patients responding to chemotherapy . Cyclophosphamide , doxorubicin , and vincristine were administered every 21 days for five cycles . Patients achieving at least partial response who had confirmation of pure small cell histologic features by pathology review and who were fit enough for thoracotomy were r and omized to undergo or not to undergo pulmonary resection . All r and omized patients received radiotherapy to the chest and brain . Two hundred seventeen ( 66 % ) of the patients achieved objective response ( 90 complete response ; 127 partial response ) . One hundred forty-six patients were r and omized ( 66 % of responders , 44 % of all patients ): 70 to surgery and 76 to no surgery . Results of surgery were 83 % resection rate , 19 % pathologic complete remission rate , and 9 % with residual non-small cell histologic features only , for a total of 28 % eradication of small cell lung cancer . The survival curves for the two arms are not different ( log rank p = 0.78 ) . Median survivals were 12 months for all enrolled patients and 16 months for those who were r and omized . Actuarial 2-year survival is 20 % . The results of this trial do not support the addition of pulmonary resection to the multimodality treatment of small cell lung cancer OBJECTIVE Indications for surgical intervention for very limited small cell lung cancer have not yet been determined . The objective of this study is to determine whether resection followed by cisplatin and etoposide is feasible . METHODS From September 1991 through December 1996 , 62 patients with completely resected small cell lung cancer who were less than 76 years of age from 17 centers were entered in the trial . Of 62 patients , 61 were eligible , with a median follow-up of 65 months . Chemotherapy consisted of 4 cycles of cisplatin ( 100 mg/m 2 , day 1 ) and etoposide ( 100 mg/m 2 , days 1 - 3 ) . There were 49 ( 80 % ) male patients , 44 with clinical stage I disease , 10 with stage II disease , and 6 with stage IIIa disease . RESULTS Forty-two ( 69 % ) patients received 4 cycles of cisplatin and etoposide . No treatment-associated mortality was noted . Median survival time was not reached in patients with pathologic stage I disease , was 449 days in patients with stage II disease , and was 712 days in patients with stage IIIa disease . Three-year survival was 61 % overall , 68 % in patients with clinical stage I disease , 56 % in patients with stage II disease , and 13 % in patients with stage IIIa disease ( P = .02 ) . Recurrence was noted in 26 ( 43 % ) patients overall . Local failure was noted in 6 ( 10 % ) patients . Locoregional recurrence tends to be found more frequently in patients with stage IIIA disease . Distant failure was found in 21 ( 34 % ) patients overall . Brain metastasis was found in 15 % of the patients . CONCLUSION Major lung resection followed by postoperative cisplatin and etoposide is feasible , with a favorable survival profile . Because nodal metastasis appears to be a major prognostic factor , preoperative evaluation of nodal status remains a major concern Abstract This report gives the 10-year results of controlled trial of a policy of surgery and a policy of radical radiotherapy in the treatment of patients with small-celled or oat-celled carcinoma of the bronchus diagnosed preoperatively on bronchial biopsy and thought likely to be operable . The analysis included 144 patients , 71 allocated at r and om to the surgery series and 73 to the radical-radiotherapy series . There were no 10-year survivors in the surgery series , but in the radiotherapy series 3 remained alive and well . The mean survival for the surgery series was 199 days and for the radical-radiotherapy series 300 days — a statistically significant difference ( P=0·04 ) . This reinforces the conclusion of the 5-year report that in this trial radical radiotherapy has given , in terms of survival , a somewhat better result than surgery in the treatment of patients with small-celled or oat-celled carcinoma of the bronchus diagnosed preoperatively on bronchial biopsy and judged to be operable OBJECTIVE The aim of the study is to analyse long-term results of patients with small cell lung cancer ( SCLC ) treated at the same institution according to a prospect i ve study including surgery , chemotherapy , and radiotherapy . METHODS From 1981 to 1995 , 104 patients with a proven histology of SCLC underwent surgery , chemotherapy , and radiotherapy . Fifty-one patients with operable stage I or II lesion received surgical resection followed by adjuvant chemotherapy and radiotherapy .  Fifty-three patients with proved SCLC and clinical stage III received induction chemotherapy followed by surgery and radiotherapy . All patients received from four to six courses of chemotherapy and 36 had prophylactic cranial irradiation ( PCI ) . All patients had follow-up for at least 1 year , and survival time was calculated from the date of the diagnosis until death or most recent follow-up . RESULTS Ninety-six patients were male and eight female . We performed 29 pneumonectomies , eight bilobectomies , 66 lobectomies and one no resection . Regarding the clinical stage , 35 patients ( 33.6 % ) had stage I , 16 patients ( 15.4 % ) had stage II and 53 ( 51 % ) had stage III . Post-operative pathologic staging revealed stage I in 37 patients ( 35.6 % ) , stage II in nine patients ( 8.6 % ) , stage III in 45 patients ( 43.3 % ) , and in 13 patients ( 12.5 % ) there was no more tumor . The 30-day mortality was 2 % ( two patients ) . Fourteen patients ( 13.4 % ) had post-operative complications . Fifty-one patients ( 49 % ) had a relapse . The median follow-up was 55 months . Twenty-six patients remain alive and 78 patients have died . The overall 5-year survival rate was 32 % , with an estimate median survival time of 28 months ; according to the pathologic stage , the survival data were 52.2 % , 30 % and 15.3 % for stage I , II and III , respectively ( P < 0.001 ) . The 5-year survival was 41 % in patients without SCLC after chemotherapy . CONCLUSION As with non-small cell lung cancer , survival following surgery and chemotherapy clearly correlates with the stage . At present , it is not clear whether surgery is truly effective for patients with SCLC . In our experience , the complete elimination of small cell lung cancer is associated with an improvement in survival ( 41 % at 5 years ) Between January 1980 and December 1986 , 42 patients with histological confirmed small-cell lung cancer ( SCLC ) staged pathologically as T1–3N0M0 disease entered a prospect i ve study of surgery plus adjuvant chemotherapy including six courses of i.v . cyclophosphamide ( 1 g/m2 , day 1 ) , epirubicin ( 60 mg/m2 , day 1 ) , and etoposide ( 120 mg/m2 , days 1 , 3 , and 5 ) , at 3-week intervals . No thoracic or prophylactic cranial irradiation was given . With a 52.5-month median follow-up , estimated 5-year survival was 36 % and median survival was 32.7 months ( range , 5–100 + ) for all patients . Seven patients ( 17 % ) are currently alive and disease-free at 63 to 100 months . In univariate analysis , baseline characteristics significantly influencing survival and disease-free interval ( DFI ) were the tumor stage ( T1 and T2 versus T3 ) , tumor histology ( oat and intermediate versus combined cell type ) , and type of resection ( lobectomy versus pneumonectomy ) . However , in multivariate analysis , only the tumor stage ( T1–2 versus T3 ) maintained its level of significance . There was a significant correlation ( p < 0.0001 ) between the pathological tumor size ( maximum tumor diameter [ ( MTD ) cm ] and survival and DFI ; once the MTD ( < versus > median value , 3.9 cm ) was included in univariate and multivariate analysis , the tumor stage no longer appeared to maintain its level of significance . Treatment was generally well-tolerated and toxicity was acceptable . This study demonstrates the effectiveness of surgery and adjuvant chemotherapy in yielding impressive long-term survival for T1 and T2N0M0 SCLC and provides evidence that the MTD can be used as a powerful and independent prognostic factor for stratification of patients in further trials
With the obvious benefit from low dose computed tomography to reduce the lung cancer-specific mortality , lung cancer screening is on the rise .
With the implementation of the screening programs , diagnosis of early stage lung cancer is expected to increase , and small cell lung cancer ( SCLC ) would account for 10 % of screen-detected lung cancer .
Apart from Concurrent chemoradiation ( CRT ) , the present guidelines virtually do not support other options for radiation ( RT ) .
There is a paucity of data addressing the role of Stereotactic Body Radiation Therapy ( SBRT ) in SCLC and we conducted the current systematic review on this topic .