The Role of Surgery in High-Grade Neuroendocrine Cancer: Indications for Clinical Practice

Frontiers in Medicine

article

Francesco Petrella¹  Claudia Bardoni¹  Monica Casiraghi¹  Lorenzo Spaggiari¹ 

[1] Department of Thoracic Surgery, IRCCS European Institute of Oncology;Department of Oncology and Hemato-Oncology, University of Milan

关键词: surgery;    small cell lung cancer;    large cell neuroendocrine carcinoma;    lobectomy;    pneumonectomy;   

DOI  :  10.3389/fmed.2022.869320

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Pulmonary neuroendocrine tumors (pNET) represent a particular type of malignant lung cancers and can be divided into well-differentiated low-grade NET and poorly-differentiated high-grade NET. Typical and atypical carcinoids belong to the first group while large cell neuroendocrine carcinomas (LCNEC) and small-cell lung cancers (SCLC) belong to the second one. The aim of this mini-review is to focus on the role of surgical therapy for high grade neuroendocrine tumors. SCLC has the worst prognosis among all lung cancer neoplasms: in fact, the two-year survival rate is about 5% and median survival usually ranges between 15 and 20 months. The surgical treatment of SCLC has thus infrequently been judged as a valuable aspect of the therapeutic approach, the gold standard treatment being a combination of platinum-based chemotherapy and radiotherapy. As LCNEC are rare, there is a lack of extensive literature and randomized clinical trials, therefore the curative approach is still controversial. Current treatment guidelines suggest treating LCNEC by surgical resection in non-metastatic stages and recommend adjuvant chemotherapy according to SCLC protocol. Upfront surgery is suggested in early stages (from I to IIB), a multimodality approach is recommended in locally advanced stages (III) while surgery is not recommended in stage IV LCNEC. The rate of surgical resection is quite low, particularly for SCLC, ranging from 1 to 6% in limited diseases; lobectomy with radical lymphadenectomy is considered the gold standard surgical procedure in the case of limited disease SCLC and resectable LCNEC; pneumonectomy, although reported as an effective tool, should be avoided in the light of local and distant recurrence rates.

【 授权许可】

CC BY