ABSTRACT
The role of surgery in the management of small cell lung cancer (SCLC) remains a controversial and as yet undecided issue despite re-examination of this role over the past 30 years. The British Medical Research Council performed two large, randomized, prospective trials of surgery versus radiotherapy in the 1960s and 1970s, which reported the failure of surgery alone to control this disease when compared to radiotherapy. 1,2 Although the results of this trial set the standards for non-surgical treatment for SCLC thereafter, this study must be criticized from the present view point for the following issues:
SCLC located in the peripheral lung was excluded • from the study since only tumors diagnosed by rigid bronchoscopy prior to the treatment were enrolled. Complete resection of the tumor could be achieved • in only 48% of the patients assigned to the ‘surgery’ arm. No intraoperative staging was done. • Modern clinical staging techniques (CT scan and • mediastinoscopy) were not used. As a result, these studies included very few patients with very early stage disease (T1-2N0M0) who are thought to benefit from surgery most.
