Surgery and Stereotactic Radiotherapy for Stage I Small-Cell Lung Carcinoma: A 25-Year Experience

Although SCLC is usually a wide-spread, highly-lethal disease, occasionally presents as localized, limited stage cancer amenable to local treatment. Our 25-year experience treating 96 patients with clinical Stage I SCLC with either surgery or SBRT (for medically inoperable patients) demonstrated safety and effectiveness, especially when followed by adjuvant chemotherapy, and has results superior to chemoradiotherapy alone. Objectives: Small-cell lung carcinoma (SCLC) is usually a wide-spread, highly-lethal malignancy but occasionally presents as localized, limited stage cancer amenable to local treatment. We reviewed our experience using surgery or stereotactic body radiotherapy (SBRT) to assess safety, survival rates and treatment toxicity in clinical stage I SCLC patients. Materials and Methods: Electronic medical records of patients with clinical stage I lymph node-negative SCLC who underwent surgical resection or SBRT between 1996 and 2021 were retrospectively reviewed. A multivariable Cox Proportional Hazards model was constructed. Results: Of 96 patients meeting inclusion criteria, 77 underwent resection and 19 underwent SBRT. Surgical patients were younger (mean 68.4 +/- 9.2 years surgery versus 74.3 +/- 6.6 years SBRT, P = .005) and had better pulmonary function (81.5 +/- 19.6 FEV1% of predicted surgery versus 44.0 +/- 20.9% SBRT, P < .001). SBRT patients had significantly more comorbidities. For both cohorts, 59 tumors were pure SCLC and 37 were mixed SCLC/NSCLC histology. Median survivals were 21 months versus 31 months for SBRT and surgery patients respectively (P = .07). There were no treatment-related mortalities. Mean length of hospital stay for surgical patients was 5.4 +/- 5.7 days. Survival was longer in lymph node-negative surgery patients (median 48 months node- negative versus 19 months node-positive, P = .04). For node-negative-surgery patients, the estimated 2- and 5-year survival rates are 60% and 48%. Conclusions: Our single-institutional experience over 25 years demonstrates that local treatment with surgery or SBRT for clinical stage I SCLC is safe and effective, with survivals lower than similar stage non-small-cell carcinoma patients. However, our results compare favorably with prior small-cell surgical series and far better than reported results of chemoradiotherapy for similar stage patients, thereby validating current recommendations for employing surgery or SBRT for stage I SCLC.