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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 168-176, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
K Karrer, TW Shields, H Denck, B Hrabar, I Vogt-Moykopf and GM Salzer
In a cooperative international lung cancer multimodality treatment trial,
112 patients with small cell lung cancer underwent initial surgical
resection and were then randomized to receive one of two intensive
postoperative chemotherapeutic regimens, followed by prophylactic cranial
irradiation in the disease-free patients. Regimen A consisted of eight
courses of cyclophosphamide, doxorubicin, and vincristine and regimen B of
two courses of three sequential drug combinations: (1) cyclophosphamide,
lomustine, and methotrexate; (2) cyclophosphamide, doxorubicin, and
vincristine; and (3) ifosfamid and etoposide. In 47 patients the diagnosis
was known preoperatively and in 65 it was not confirmed until the resected
specimen was examined (all diagnoses were reviewed by a referee
pathologist). Each patient was classified by the pathologic TNM
characteristics. There were 38 patients with stage I disease, 39 patients
with stage II, and 35 patients with stage IIIa disease. In stage IIIa there
were nine patients with T3 N0-1 disease and 26 with T1-3 N2 disease (most
N2 disease was clinically undetected until thoracotomy or was discovered
only by routine histologic examination of the resected mediastinal nodes).
Early survival rates at 24 months calculated by the life table method are
as follows: stage I, 76%; stage II, 56%; and stage IIIa, 49% (T3 N0-1, 89%;
T1-3 N2, 35%). Survival rates at 36 months are 62%, 50%, and 41% (74% and
29%), respectively. The projected 36-month survival rate for 43 patients
with N0 disease is 65%; for 43 with N1 disease, 52%; and for 26 with N2
disease, 29%. No difference in survival has been noted in either
chemotherapy treatment group. It is concluded that initial surgical
resection for limited small cell cancer (stage I, II, and T3 N0-1) followed
by intensive chemotherapy is an appropriate therapeutic approach. For T1-3
N2 disease the results are inconclusive.
ARTICLES
The importance of surgical and multimodality treatment for small cell bronchial carcinoma
Northwestern University Medical School, Department of Surgery, Chicago, IL 60611.
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 R. Tsuchiya, K. Suzuki, Y. Ichinose, Y. Watanabe, T. Yasumitsu, N. Ishizuka, and H. Kato Phase II trial of postoperative adjuvant cisplatin and etoposide in patients with completely resected stage I-IIIa small cell lung cancer: The Japan Clinical Oncology Lung Cancer Study Group Trial (JCOG9101) J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 977 - 983. [Abstract] [Full Text] [PDF]
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