Effect of initial resection of small-cell carcinoma of the lung: a review of Southwest Oncology Group Study 7628.

Abstract

The role of surgery in small-cell carcinoma of the lung (SCCL) has been recently re-evaluated. We reviewed the records of 262 patients with limited SCCL on Southwest Oncology Group (SWOG) protocol 7628. Fifteen patients were identified who presented after surgical resection (12 lobectomy, three pneumonectomy). All patients were subsequently treated with chemotherapy, radiotherapy +/- immunotherapy (BCG). Median survival time was 10.5 months. Median survival time of patients with initial surgical resection was 25 months (P = .004). Forty-five percent of the surgical patients were alive at two years v 13.7% of the nonsurgical patients (P less than .05). A second subgroup of 33 patients was identified with small primary tumors who did not undergo surgical resection. Median survival time in this group was ten months (P = .03). Site of initial relapse was clearly documented in 142 patients. Fifty-six percent of patients not receiving surgery had initial relapse within the chest compared to 13% of patients undergoing surgery (P = .002). Whether the survival benefit identified was caused by or was incidental to surgical resection of the primary lesion remains to be determined in randomized prospective trials of operable candidates.

Surgical resection of limited disease small cell lung cancer in the new era of platinum chemotherapy: Its time has come

“…24 As observed in older studies, disease that had advanced enough to involve hilar or mediastinal lymph nodes significantly reduced the 5-year survival of any patient. 8,15,16,25 Our study achieved similar overall 5-year survivals by stage as previous adjuvant series (Table 2). Our observations confirm that if modern preoperative clinical staging can correctly identify cT1-2 N0 SCLC, and if complete surgical removal of the lesion is possible, platinum-based adjuvant chemotherapy can lead to long-term survival.…”

Role of pulmonary resection in the diagnosis and treatment of limited-stage small cell lung cancer: revision of clinical diagnosis based on findings of resected specimen and its influence on survival

“…Particularly, patients with earlystage disease (e.g., T1-2N0 stage 1) are good candidates for "curative" surgical treatment by complete macroscopic resection as a part of the multimodal treatment for LD-SCLC. 2,22,23 Although the effectiveness of perioperative chemotherapy could not be confi rmed in this study, we believe that perioperative chemotherapy is highly important and is strongly recommended according to the reported data. 24,25 Preoperatively established clinical staging may not correctly represent the postoperatively confi rmed pathological staging.…”

A retrospective comparative study of surgery followed by chemotherapy vs. non-surgical management in limited-disease small cell lung cancer

“…Other retrospective comparative studies showed contradictory results. Southwest Oncology Group Protocol 7628 demonstrated two-year survival of 45 and 14% in patients treated with and without surgery, respectively, [15], whereas in the retrospective study of Valdiviesco et al [16] the use of surgery was not associated with any survival gain.…”