Revisiting the Role of Surgery in Brain Metastatic Small Cell Lung Cancer: Survival Benefit in Selected Patients

Purpose Small-cell lung cancer (SCLC) has a high propensity for early brain dissemination. With advances in focal therapies, the question arises whether surgery may have a role in selected patients with limited intracranial disease. Unlike in non–small cell lung cancer (NSCLC), the benefit of neurosurgical resection in SCLC remains uncertain. This study examined whether, in selected cases, surgical resection of brain metastases confers a meaningful survival advantage. Methods We retrospectively analyzed 39 patients with histologically confirmed SCLC and up to three brain metastases. Thirteen patients underwent resection followed by adjuvant therapy (surgery-group), and twenty-six were treated without surgery (non-surgical group) using radiotherapy and/or chemotherapy. To isolate the affect of extracranial disease, we applied a modified staging system classifying extracranial burden independently of intracranial status. Survival analyses were conducted using Kaplan–Meier estimates and Cox regression models. Results Median overall survival (OS) was 25.1 months in the surgery group versus 5.8 months in the non-surgical group (p = 0.001). On multivariable analysis, surgery was an independent predictor of longer OS (HR 4.88,95%CI 1.57–15.19, p = 0.006). The benefit of surgery persisted across both high and low Karnofsky Performance Scale (KPS) subgroups (p < 0.05). The median interval from SCLC diagnosis to brain metastasis onset was comparable between groups (8.7 vs. 9.1 months, p = 0.78). Conclusions When feasible, neurosurgical resection may substantially prolong survival in selected SCLC patients with limited brain metastases. This benefit appears independent of baseline performance or timing of brain involvement, warranting prospective validation and supporting surgery within a multimodal treatment approach.