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The Journal of Thoracic and Cardiovascular Surgery, Vol 84, 481-488, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TW Shields, GA Higgins Jr, MJ Matthews and RJ Keehn
In an attempt to define the role of initial surgical resection in patients
with undifferentiated small cell carcinoma of the lung, we reviewed the
experience of the Veterans Administration Surgical Oncology Group (VASOG).
One hundred forty-eight patients with small cell carcinoma of the lung had
undergone a potentially "curative" resection. This represented 4.7% of
"curative" resections carried out in four major prospective adjuvant
chemotherapy trials. In the early trials (101 patients), 16 patients
(15.8%) died within the first 30 postoperative days. These patients have
been excluded from the analysis of long-term survival, since in the more
recent trials postoperative deaths were excluded prior to randomization. In
the 132 patients remaining, the 5 year survival rate by the life-table
method was 23.0%. The tumor of each was classified pathologically by the
TNM system. Five- year survival rates for each category were as follows: T1
N0 M0 59.9%, T1 N1 M0 31.3%, T2 N0 M0 27.9%, T2 N1 M0 9.0%, and any T3 or
N2 3.6%. The effect of postoperative adjuvant chemotherapy was evaluated in
each of the trials. No beneficial effect of the adjuvant therapy was noted
with a one or two course regimen of either nitrogen mustard or
cyclophosphamide, but possible benefit, although not significant, was noted
in a prolonged intermittent chemotherapy trial of cyclophosphamide either
alone or alternating with methotrexate. In the most recent trial of
prolonged intermittent courses of 1-(2-chlorethyl)-
3-cyclohexyl-l-nitrosourea (CCNU) and hydroxyurea, a 5 year survival rate
of 80.8% was noted in those receiving adjuvant chemotherapy as compared to
a 38.1% in the control group. We conclude that resection is definitely
indicated in patients with T1 N0 M0 lesions and probably indicated in those
with T1 N1 M0 or T2 N0 M0 lesions. Primary surgical resection is
contraindicated in patients with any other TNM category.
ARTICLES
Surgical resection in the management of small cell carcinoma of the lung
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