Surgery in the management of small cell lung cancer

• Published in: European journal of cardio-thoracic surgery Vol. 12; no. 5; pp. 689 - 693
• Main Authors: LUCCHI, M, MUSSI, A, CHELLA, A, JANNI, A, RIBECHINI, A, MENCONI, G. F, ANGELETTI, C. A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.11.1997; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Small Cell - drug therapy; Carcinoma, Small Cell - mortality; Carcinoma, Small Cell - surgery; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Lung Neoplasms - therapy; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Pneumonectomy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Survival Rate; Human; Chemotherapy; Prognosis; Treatment; Respiratory disease; Surgery; Treatment efficiency; Adjuvant treatment; Malignant tumor; Small cell carcinoma; Bronchopulmonary
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)00161-9

OBJECTIVE: We analyzed our experience in the period January 1975-December 1995 aiming to confirm the role of surgery in the multimodality treatment of small cell lung cancer (SCLC). METHODS: 127 patients (5.28% of the overall lung resections for carcinoma) underwent surgery for SCLC. The median age was 60 years (range 34-73). In 87 patients (68.5%) a pre-operative tissue diagnosis was effected and those patients underwent a complete staging procedure. Fifteen patients received up to six complete courses of neoadjuvant and adjuvant chemotherapy. The surgical proceduresincluded: 50 pneumonectomies, 71 lobectomies and six wedge resections. Two patients experienced a local recurrence and a completion pneumonectomy was performed. RESULTS: The median follow-up is 66 months (range 6-214). The 5-year actuarial survival rate is 22.6% (median 18 months). Twenty-three patients are still alive, 21 of them being disease-free. Considering the most conspicuous group of patients (n = 92) treated by surgery and adjuvant chemotherapy, the survival data were 47.2, 14.8 and 14.4% for Stage I, IIand III, respectively (P = 0.001). NO patients had a significantly better survival than N1 and N2 patients (P = 0.035). CONCLUSIONS: Surgery and adjuvant chemotherapy might represent an effective form of treatment of limited SCLC without lymph-node involvement. The role of surgery is yet to be verified as regards N1 and N2 status, where even neoadjuvant chemotherapy has not achieved the hoped-for results (no patient reaching a 2-year survival).