Surgery in SCLC as first step of multimodality treatment.

186 patients received surgery for cure followed by aggressive randomized chemotherapy and PCI. After a median follow-up time of about 60 months the observed 4-year overall survival rate for patients completely resected was: 58% for 68 patients with pT1-3N0M0, and 33% for 27 patients with pT1-3 pN2M0 stages of SCLC. These promising results have to be confirmed by larger cooperative studies to support the recommendation to initiate surgery without delay, i.e. without preoperative chemotherapy for SCLC as well as for the non-SCLCs. From 148 patients in ISC study III after preoperative (neoadjuvant) chemotherapy only 12 received surgery for pT1-3N2M0 but only one of them survived 36 months and none 48 months p.o.