Contrasting Management of Small Cell Lung Cancer and Non-Small Cell Lung Cancer: Emerging Data for Low-Dose Computed Tomography Screening.

In 1973, Mary Matthews published a classic study describing the frequency of residual and metastatic tumor in patients undergoing curative resection of lung cancer. 1 The data set included 202 patients with all histologic types of lung cancer who had had their tumor resected for cure but died of all causes, including postoperative complications, within 30 days of surgery. At autopsy, residual cancer was observed in 35% of the patients. Of the 19 patients with small cell lung cancer (SCLC), however, 13 (70%) had residual disease (present at distant sites in 12 of 13). Although the number of patients was small, this paper changed how clinicians thought about SCLC. The initial sensitivity of SCLC to chemotherapy and radiotherapy was recognized by Watson and Berg. 2 Other clinical 3 and laboratory studies 4 established SCLC as a distinct clinicopathologic entity. Indeed, SCLC and non-SCLC (NSCLC) are generally discussed as separate topics. After 50 years of investigation, it is recognized that there are many similarities as well as differences between the therapeutic principles of treatment of the two diseases. For operable cases without mediastinal lymph node involvement, surgical resection followed by assessment for adjuvant chemotherapy is recommended. The standard of care for unresectable locally advanced SCLC and NSCLC is early concurrent chemoradiation. For both lung cancer subtypes, cisplatin-etoposide as the chemotherapy component of combined modality therapy has never been demonstrated to be inferior to any other regimen. The median survival for locally advanced disease with initial chemoradiation is approximately the same, with a median survival time of 20 to 24 months and a 5-year survival rate of 20%. For metastatic disease, the palliative first-line sys