The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 283-290, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Histologic alterations in small cell carcinoma of the lung after two cycles of intensive chemotherapy
JA Meyer, PM Ikins, JJ Gullo, RL Comis, WA Burke, SM DiFino and FB Parker Jr
In patients treated nonsurgically for "limited" small cell carcinoma of the
lung, the most frequent site of relapse is within the chest. We have
treated patients with clinical Stage III M0 disease (T3 and/or N2, M0) by
two cycles of chemotherapy, surgical resection of the primary site and
mediastinal nodes, and continued chemotherapy thereafter. Since May, 1979,
the regimen has consisted of cyclophosphamide, doxorubicin, vincristine,
and etoposide on a 3 week cycle. The first 12 patients so treated had
partial or complete remission after two cycles. Resection was technically
not possible in two. Residual small cell carcinoma was not identifiable in
the specimens from two of the 10 patients undergoing resection. Microscopic
tumor extended to a resection line in two of the eight with residual tumor.
Malignant tissue appearing to have the structure of papillary
adenocarcinoma was found in hilar and paratracheal nodes in one patient,
but nowhere in the resected lung; some residual small cell carcinoma
remained in the lung. Nuclear ballooning and eosinophilic inclusions were
noted in cells still identifiable as small cell carcinoma in one case.
Marked fibrotic scarring was noted in eight cases, acute and organizing
bronchopneumonia in three, and multiple small parenchymal abscesses in one
case. Long disease-free survival occurred in one patient, in whom residual
tumor could not be found in the specimen; in at least one more in whom
residual tumor was present; and even in one patient in whom tumor was
present at the bronchial resection line.
