Outcome of Surgery for Small Cell Lung Cancer - Response to Induction Chemotherapy Predicts Survival

Abstract

Background: The role of surgery for local control of small cell lung cancer (SCLC) is controversial. Methods: Sixty-nine consecutive patients who underwent complete resection of SCLC in our hospital were reviewed. The patients included 62 men and 7 women. Clinical stage at the time of diagnosis was c-stages IA and B in 29, c-stages IIA and B in 12, c-stage IIIA in 21, and c-stage IIIB in 7. Results: Thirty-two patients received induction chemotherapy, and 37 patients underwent initial surgery. The overall response rate to induction chemotherapy was 71.9 %. The survival rate stratified by clinical stage at the time of diagnosis was 48.9 % for c-stage I, 33.3 % for c-stage II, 20.2 % for c-stage IIIA, and 0 % for c-stage IIIB. Downstaging after induction chemotherapy conferred a survival benefit. Survival after lobectomy or bilobectomy was better than after pneumonectomy. Patients who received adjuvant chemotherapy survived longer than patients who did not. Conclusions: Surgery combined with chemotherapy is a therapeutic option in selected patients with SCLC. Pathologic nodal status and response to induction chemotherapy are predictors of survival.

Chemotherapy - lung cancer - surgery - survival - small cell lung cancer

References

• 1 Fox W, Scadding J. Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus. Ten-year follow-up.  Lancet. 1973;  2 63-65
• 2 Coy P, Hodson D, Murray N. et al . Patterns of failure following loco-regional radiotherapy in the treatment of limited stage small cell lung cancer.  Int J Radiat Oncol Biol Phys. 1994;  28 355-362
• 3 Shields T, Higgins G, Matthews M. et al . Surgical resection in the management of small cell carcinoma of the lung.  J Thorac Cardiovasc Surg. 1982;  84 481-488
• 4 Shepherd F, Ginsberg R, Feld R. et al . Surgical treatment for limited small-cell lung cancer. The University of Toronto Lung Oncology Group experience.  J Thorac Cardiovasc Surg. 1991;  101 385-393
• 5 Lad T, Piantadosi S, Thomas P. et al . A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy.  Chest. 1994;  106 320S-323S
• 6 Mentzer S, Reilly J, Sugarbaker D. Surgical resection in the management of small-cell carcinoma of the lung.  Chest. 1993;  103 349S-351S
• 7 Baker R, Ettinger D, Ruckdeschel J. et al . The role of surgery in the management of selected patients with small-cell carcinoma of the lung.  J Clin Oncol. 1987;  5 697-702
• 8 Eberhardt W, Stamatis G, Stuschke M. et al . Prognostically orientated multimodality treatment including surgery for selected patients of small-cell lung cancer patients stages IB to IIIB: long-term results of a phase II trial.  Br J Cancer. 1999;  81 1206-1212
• 9 Mountain C. Revisions in the International System for Staging Lung Cancer.  Chest. 1997;  111 1710-1717
• 10 Travis D, Colby V, Corrin B. et al .Histological Typing of Lung and Pleural tumors. Heidelberg; Springer 1999
• 11 Szczesny T, Szczesna A, Shepherd F. et al . Surgical treatment of small cell lung cancer.  Semin Oncol. 2003;  30 47-56
• 12 Perez C, Einhorn L, Oldham R. et al . Randomized trial of radiotherapy to the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report.  J Clin Oncol. 1984;  2 1200-1208
• 13 Kies M, Mira J, Crowley J. et al . Multimodal therapy for limited small-cell lung cancer: a randomized study of induction combination chemotherapy with or without thoracic radiation in complete responders; and with wide-field versus reduced-field radiation in partial responders: a Southwest Oncology Group Study.  J Clin Oncol. 1987;  5 592-600
• 14 Passlick B. Can surgery improve local control in small cell lung cancer?.  Lung Cancer. 2001;  33 147S-151S
• 15 Hara N, Ohta M, Ichinose Y. et al . Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer.  J Surg Oncol. 1991;  47 53-61
• 16 Coolen L, Van den Eeckhout A, Deneffe G. et al . Surgical treatment of small cell lung cancer.  Eur J Cardiothorac Surg. 1995;  9 59-64
• 17 Rea F, Callegaro D, Favaretto A. et al . Long term results of surgery and chemotherapy in small cell lung cancer.  Eur J Cardiothorac Surg. 1998;  14 398-402
• 18 Shah S, Thompson J, Goldstraw P. Results of operation without adjuvant therapy in the treatment of small cell lung cancer.  Ann Thorac Surg. 1992;  54 498-501
• 19 Davis S, Crino L, Tonato M. et al . A prospective analysis of chemotherapy following surgical resection of clinical stage I-II small-cell lung cancer.  Am J Clin Oncol. 1993;  16 93-95
• 20 Wada H, Yokomise H, Tanaka F. et al . Surgical treatment of small cell carcinoma of the lung: advantage of preoperative chemotherapy.  Lung Cancer. 1995;  13 45-56