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 Feld, R. Search for Related Content PubMed PubMed Citation Articles by Shepherd, F. A. Articles by Feld, R.

The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 177-186, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

A prospective study of adjuvant surgical resection after chemotherapy for limited small cell lung cancer. A University of Toronto Lung Oncology Group study

FA Shepherd, RJ Ginsberg, GA Patterson, WK Evans and R Feld
Department of Medicine, Toronto General Hospital, Ontario, Canada.

Seventy-two patients with limited small cell lung cancer were identified as candidates for adjuvant operation after chemotherapy. All patients received preoperative chemotherapy with cyclophosphamide, doxorubicin HCl (Adriamycin), and vincristine, or the epipodophyllotoxin derivative VP-16 and cisplatin. The rate of response to chemotherapy was 80% (complete response 38% and partial response 42%). After chemotherapy, 57 patients (79.1%) were candidates for adjuvant surgical resection, but only 38 underwent thoracotomy. Eight required a pneumonectomy, 25 a lobectomy, and five patients had no resection. Postoperative pathologic study revealed only small cell lung cancer for 29 patients, mixed and non-small cell lung cancer for two, non-small cell lung cancer for four, and no residual tumor in three patients. Pathologic staging revealed seven patients in stage I (N0), nine in stage II (N1), and 22 in stage III. The median survival time for the 38 surgical patients was 91 weeks and projected 5-year survival rate 36%. Patients with pathologic stage I disease had significantly longer survival times (median not reached) than did patients in stage II or stage III (median survival 69 and 52 weeks, respectively). Within the group not undergoing operation, 19 patients responded to therapy and were eligible for adjuvant surgical resection, but did not undergo thoracotomy (10 patients were randomized to radiation only, and nine patients refused operation). Their median survival of 51 weeks was inferior to that of the 38 surgical patients (p = 0.049). Adjuvant surgical resection after chemotherapy resulted in long-term survival and cure for a significant proportion of patients with pathologic stage I disease. A significant improvement in survival could not be documented for patients in stages II and III. Intensive pretreatment investigation including mediastinoscopy is essential to exclude patients who will not benefit from adjuvant surgical resection.

This article has been cited by other articles:

				D. J. Samson, J. Seidenfeld, G. R. Simon, A. T. Turrisi III, C. Bonnell, K. M. Ziegler, and N. Aronson Evidence for Management of Small Cell Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 314S - 323S. [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]

				A. Badzio, K. Kurowski, H. Karnicka-Mlodkowska, and J. Jassem A retrospective comparative study of surgery followed by chemotherapy vs. non-surgical management in limited-disease small cell lung cancer Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 183 - 188. [Abstract] [Full Text] [PDF]

				T. Lewinski, M. Zulawski, C. Turski, and A. Pietraszek Small cell lung cancer I-III A: cytoreductive chemotherapy followed by resection with continuation of chemotherapy Eur. J. Cardiothorac. Surg., August 1, 2001; 20(2): 391 - 398. [Abstract] [Full Text] [PDF]

				S. Bandoh, J. Fujita, Y. Ueda, Y. Fukunaga, K. Dohmoto, S. Hojo, Y. Yang, Y. Yamaji, J. Takahara, and T. Ishida Expression of Carcinoembryonic Antigen in Peripheral- or Central-located Small Cell Lung Cancer: Its Clinical Significance Jpn. J. Clin. Oncol., July 1, 2001; 31(7): 305 - 310. [Abstract] [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]