Optimal local therapy for early-stage small cell lung cancer: surgery needs a seat at the table

The National Comprehensive Cancer Network (NCCN) guidelines, in addition to other international societies, recommend surgery for American Joint Committee on Cancer clinical stage I small cell lung cancer (SCLC) after a careful radiographic evaluation excludes distant metastases and invasive mediastinal staging excludes nodal disease. However, the data to support these guidelines are limited and therefore it is suspected that these guidelines are not universally followed (1). Yang and colleagues recently published their analysis of data from the National Cancer Database (NCDB) comparing overall survival (OS) in patients with cT1-2N0M0 SCLC who underwent surgery with adjuvant chemotherapy with or without adjuvant radiation therapy to OS in those treated with only concurrent chemoradiation (2).