HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shepherd, F. A. Articles by Johansen, E. Search for Related Content PubMed PubMed Citation Articles by Shepherd, F. A. Articles by Johansen, E.

The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 385-393, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Surgical treatment for limited small-cell lung cancer. The University of Toronto Lung Oncology Group experience

FA Shepherd, RJ Ginsberg, R Feld, WK Evans and E Johansen
Department of Medicine, Toronto General Hospital, ON., Canada.

Since 1977, 119 patients with limited small-cell lung cancer have undergone combined modality therapy including surgery at our institution. Seventy-nine patients (58 male, 21 female; median age 63 years) had surgery first, and 67 of these had adjuvant chemotherapy. Forty (27 male, 13 female; median age 59 years) had chemotherapy first, and 94% had a complete or partial response before the operation. Pretreatment staging revealed 69 stage I, 27 stage II, and 23 stage III tumors. Twenty-six patients required pneumonectomy, 88 lobectomy, and five had no resection. Four patients had gross and six had microscopic residual disease. Postoperative pathologic examination showed small- cell lung cancer only (n = 95), non-small-cell lung cancer (n = 3), mixed (n = 17), and no residual tumor (n = 4). Postoperative staging revealed 35 stage I, 36 stage II, and 48 stage IIIa tumors. The median survival of the entire group is 111 weeks and the projected 5-year survival rate is 39%. No survival difference was seen between patients treated with chemotherapy before the operation and those undergoing an initial operation followed by chemotherapy (p = 0.756). The median survival for patients with pathologic stage I disease has not been reached, and the projected 5-year survival rate is 51%. This is significantly better than for the patients with stage II (median 82 weeks, p = 0.001) or stage III (median 83 weeks, p = 0.001) disease, who have projected 5-year survival rates of 28% and 19%, respectively. Seven of the 12 patients who had no adjuvant chemotherapy remain alive at 6 to 48+ months. Sixty-seven patients have died (11 had no evidence of disease). Only 10 patients had a relapse in the primary site alone, seven at the primary and distant sites, and 39 only in distant sites. In summary, resection improves control at the primary site, and a significant proportion of patients with stage I (N0) disease achieve long-term survival and cure with combined modality therapy including surgery. Stage II and IIIa patients have survival predictions similar to stage IIIa non-small-cell lung carcinoma treated surgically.

This article has been cited by other articles:

				G. R. Simon and A. Turrisi Management of Small Cell Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 324S - 339S. [Abstract] [Full Text] [PDF]

				M. Sakai, S. Ishikawa, T. Yamamoto, M. Onizuka, Y. Sakakibara, T. Iijima, and M. Noguchi Preoperative TNM evaluation of peripheral clinical stage I small cell lung cancer treated by initial lobectomy with adjuvant chemotherapy Interactive CardioVascular and Thoracic Surgery, April 1, 2005; 4(2): 118 - 122. [Abstract] [Full Text] [PDF]

				H. Rostad, A. Naalsund, R. Jacobsen, T. E. Strand, H. Scott, E. H. Strom, and J. Norstein Small cell lung cancer in Norway. Should more patients have been offered surgical therapy? Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 782 - 786. [Abstract] [Full Text] [PDF]

				E. M. Kamel, D. Zwahlen, M. T. Wyss, K. D. Stumpe, G. K. von Schulthess, and H. C. Steinert Whole-Body 18F-FDG PET Improves the Management of Patients with Small Cell Lung Cancer J. Nucl. Med., December 1, 2003; 44(12): 1911 - 1917. [Abstract] [Full Text] [PDF]

				J. Zacharias, A. G. Nicholson, G. P. Ladas, and P. Goldstraw Large cell neuroendocrine carcinoma and large cell carcinomas with neuroendocrine morphology of the lung: prognosis after complete resection and systematic nodal dissection Ann. Thorac. Surg., February 1, 2003; 75(2): 348 - 352. [Abstract] [Full Text] [PDF]

				D R Baldwin, T Eaton, J Kolbe, T Christmas, D Milne, J Mercer, E Steele, J Garrett, M L Wilsher, and A U Wells Management of solitary pulmonary nodules: how do thoracic computed tomography and guided fine needle biopsy influence clinical decisions? Thorax, September 1, 2002; 57(9): 817 - 822. [Abstract] [Full Text] [PDF]

				M. Lucchi, A. Mussi, G. Fontanini, P. Faviana, A. Ribechini, and C. A. Angeletti Small cell lung carcinoma (SCLC): the angiogenic phenomenon Eur. J. Cardiothorac. Surg., June 1, 2002; 21(6): 1105 - 1110. [Abstract] [Full Text] [PDF]

				A. Toker, S. Dilege, and G. Kalayci Combined left pneumonectomy and off-pump coronary artery bypass: principles of cancer surgery Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 370 - 371. [Full Text] [PDF]

				British Thoracic Society, Society of Cardiothoracic Surgeons of Great Britai, and Ireland Working Party Guidelines on the selection of patients with lung cancer for surgery Thorax, February 1, 2001; 56(2): 89 - 108. [Full Text]

				M. Inoue, S. Miyoshi, T. Yasumitsu, T. Mori, K. Iuchi, H. Maeda, and H. Matsuda Surgical results for small cell lung cancer based on the new TNM staging system Ann. Thorac. Surg., November 1, 2000; 70(5): 1615 - 1619. [Abstract] [Full Text] [PDF]

				M. Inoue, K. Nakagawa, K. Fujiwara, K. Fukuhara, and T. Yasumitsu Results of preoperative mediastinoscopy for small cell lung cancer Ann. Thorac. Surg., November 1, 2000; 70(5): 1620 - 1623. [Abstract] [Full Text] [PDF]

				F. Rea, D. Callegaro, A. Favaretto, M. Loy, A. Paccagnella, U. Fantoni, G. Festi, and F. Sartori Long term results of surgery and chemotherapy in small cell lung cancer Eur. J. Cardiothorac. Surg., October 1, 1999; 14(4): 398 - 402. [Abstract] [Full Text] [PDF]