Small cell lung cancer is considered by many to be a systemic disease since at initial presentation nearly two-thirds of patients have disease outside the thorax involving at least one other organ. It is felt by some that the diagnosis of small cell carcinoma in the lung, in and of itself, is not resectable because of presumed systemic metastases. Regardless of the ability to document all sites of micrometastases, chemotherapy is considered the first line of treatment for small cell carcinoma. Because of this, the TNM classification is occasionally not used for small cell carcinoma; it is presumed that all such cases have micrometastases systemically. In any event the TNM system should be employed for small cell carcinoma since most thoracic surgeons now feel that there are specific indications for resecting small cell lung carcinoma. These indications, for example, may include a patient with a Stage I peripheral small cell carcinoma without mediastinal involvement. Resection may result in cure. Some groups have reported a 5 year survival rate of almost one-third following surgical management of small cell lung cancer.

Surgery in small cell lung cancer is limited to about 10% of all patients. Surgical management may play a role in the treatment of small cell lung carcinoma but must be done in conjunction with chemotherapy, either preoperative or postoperative, or both, with or without radiation therapy.

Currently, resection of stage I and II small cell lung cancer with pre- or postoperative chemotherapy is the recommended treatment with additional medias-tinal radiation therapy of N-1 positive disease. No resection is indicated if N-2 disease, i.e. mediastinal disease, is involved. Also, prophylactic cranial radiation is performed in cases of small cell lung cancer because of the high risk of brain metastases.

Chemotherapy regimens generally used for small cell lung cancer include cy-clophosphamide, doxorubicin and vincristine. Without treatment, small cell lung cancers are rapidly fatal with the mean duration of survival less than 3 months.

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