The Journal of Thoracic and Cardiovascular Surgery, Vol 70, 590-605, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Long-term intermittent adjuvant chemotherapy for primary, resected lung cancer
H Katsuki, K Shimada, A Koyama, M Okita and Y Yamaguchi
Adjuvant chemotherapy for lung cancer has previously been unsuccessful in
improving the results of pulmonary resections. During a 12 year period, we
tested long-term intermittent chemotherapy (LTIC) with mitomycin C and
chromomycin A3 adjuvant to resections. LTIC was begun before the operations
and the first course was completed postoperatively. Additional courses of 4
weeks each were scheduled at 3 month intervals during the first
postoperative year and at 6 month intervals during the next 2 years. LTIC
was defined as three or more full courses, and short-term chemotherapy
(STC) was defined as a single course of adjuvant treatment. Resections for
cancer in 425 patients over a 22 year period included 117 operations during
a 10 year control period in which LTIC was not used and 308 during the LTIC
test period. Results from adjuvant LTIC in 85 patients were compared with
lesser adjuvant chemotherapy in 155 synchronously treated patients who
included 77 STC recipients. Further comparison was made between LTIC and
asynchronously treated, comparable control subjects. Although there were
side effects and occasional deaths from chemotherapy, they did not alter
the operative mortality rate. The over-all 5 year survival rate of the
adjuvant LTIC patients was 50.9 per cent, as compared to 22.6 per cent in
the asynchronous control subjects (p less than 0.01). For patients who were
given LTIC adjuvant to palliative resections the 5 year survival rate was
35.6 per cent, as compared to 4.3 per cent for STC patients or 5.2 per cent
for asychronous control subjects (p less than 0.01). Strikingly promising
results were obtained from adjuvant LTIC in 10 of 33 patients with
undifferentiated cancers. We conclude that LTIC prolonged life among lung
cancer patients who were not cured by resection alone. Dual-agent LTIC is
safe, apparently beneficial, and worthy of further clinical trials in a
research setting.
