J.Jpn. Surg. Soc.. 122(1): 38-42, 2021

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Feature topic

TREATMENT OF SMALL-CELL LUNG CANCER

Small-cell lung cancer (SCLC) accounts for 10–13% of all lung cancers and is a highly malignant neuroendocrine tumor with a poor prognosis. Systemic chemotherapy with cytotoxic anticancer agents is the main treatment, but surgery may be selected for early cases without lymph node or distant metastases. Indications for surgery are limited to stageⅠ–ⅡA (UICC-TNM, 8th edition) of localized disease, and long-term survival can be expected when surgery is followed by postoperative adjuvant chemotherapy. In resected cases, the 5-year survival rate is reported to be 30–50%, and the median survival time is 16–48 months. For postoperative adjuvant chemotherapy, 4 courses of cisplatin (CDDP) + etoposide (EP) are the standard treatment. In a recent clinical trial (JCOG1205/1206), the superiority of postoperative CDDP + irinotecan (IP) over EP was not confirmed. For unresectable stageⅠcases, good local control with stereotactic body radiotherapy (SBRT) was reported. On the other hand, as a standard treatment for extensive disease (ED-SCLC), IP therapy is strongly recommended as a result of clinical trials in Japan. In recent years, CBDCA + EP + atezolizumab has been indicated as the first-line treatment for ED-SCLC. We hope that SCLC can be better controlled by precision diagnosis and the development of new drug therapies.

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