Adjuvant surgery after carboplatin and VP16 in resectable small cell lung cancer

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Abstract

INTRODUCTION: The real benefit of surgical treatment of small cell lung cancer (SCLC) has never been demonstrated, mainly because of the rarity of surgical cases and the difficulty in comparing surgical and medical series for the different classifications systems used by surgeons (tumor, node, metastasis) and medical oncologists and radiotherapists (Veterans Administrations Lung Cancer Study Group). MATERIALS AND METHODS: We prospectively assessed the utility of surgery after chemotherapy (carboplatin plus VP16 with or without ifosfamide) with or without radiotherapy in 23 patients with preoperative diagnosis of resectable stage I to IIIA SCLC. A median of three (range: three to six) courses of chemotherapy were administered. Five pneumonectomies, 12 lobectomies (seven sleeve resections), and two segmentectomies were performed, and all except one received radical lymph node dissection. Four (17%) patients received exploratory thoracotomy. Nine (39%) patients received postoperative thoracic radiotherapy. RESULTS: Pathological stages were complete response in four patients, stage I in seven patients, stage II in seven patients, and stage III in five patients. Thirty-day morbidity and mortality were 9% and 0%, respectively. Surgery-related mortality at 90 days was 9%. Median follow-up was 19 months. Overall and local relapse rates were 52% and 17%, respectively. Median overall and disease-free survival were 24 and 12 months. Patients with complete response or pathological stage I had a significantly better Kaplan-Meier survival and lower incidence of relapse than those with more advanced pathological stage (p = 0.025 and 0.027, respectively, log rank). CONCLUSIONS: Survival after chemotherapy and surgery in the series correlated with pathological but not pretreatment stage. Only patients with pathological stage 0 or I disease seem to benefit from surgical resection.

Original languageEnglish
Pages (from-to)131-134
Number of pages4
JournalJournal of Thoracic Oncology
Volume2
Issue number2
Publication statusPublished - Feb 2007

Fingerprint

Carboplatin
Small Cell Lung Carcinoma
Drug Therapy
Radiotherapy
Recurrence
Ifosfamide
United States Department of Veterans Affairs
Survival
Segmental Mastectomy
Pneumonectomy
Mortality
Thoracotomy
Lymph Node Excision
Disease-Free Survival
Lung Neoplasms
Thorax
Neoplasm Metastasis
Morbidity
Incidence

Keywords

  • Chemotherapy
  • Induction treatment
  • Small cell lung cancer
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

@article{3171ceb1dbea484494c0f87712f2bbcd,
title = "Adjuvant surgery after carboplatin and VP16 in resectable small cell lung cancer",
abstract = "INTRODUCTION: The real benefit of surgical treatment of small cell lung cancer (SCLC) has never been demonstrated, mainly because of the rarity of surgical cases and the difficulty in comparing surgical and medical series for the different classifications systems used by surgeons (tumor, node, metastasis) and medical oncologists and radiotherapists (Veterans Administrations Lung Cancer Study Group). MATERIALS AND METHODS: We prospectively assessed the utility of surgery after chemotherapy (carboplatin plus VP16 with or without ifosfamide) with or without radiotherapy in 23 patients with preoperative diagnosis of resectable stage I to IIIA SCLC. A median of three (range: three to six) courses of chemotherapy were administered. Five pneumonectomies, 12 lobectomies (seven sleeve resections), and two segmentectomies were performed, and all except one received radical lymph node dissection. Four (17{\%}) patients received exploratory thoracotomy. Nine (39{\%}) patients received postoperative thoracic radiotherapy. RESULTS: Pathological stages were complete response in four patients, stage I in seven patients, stage II in seven patients, and stage III in five patients. Thirty-day morbidity and mortality were 9{\%} and 0{\%}, respectively. Surgery-related mortality at 90 days was 9{\%}. Median follow-up was 19 months. Overall and local relapse rates were 52{\%} and 17{\%}, respectively. Median overall and disease-free survival were 24 and 12 months. Patients with complete response or pathological stage I had a significantly better Kaplan-Meier survival and lower incidence of relapse than those with more advanced pathological stage (p = 0.025 and 0.027, respectively, log rank). CONCLUSIONS: Survival after chemotherapy and surgery in the series correlated with pathological but not pretreatment stage. Only patients with pathological stage 0 or I disease seem to benefit from surgical resection.",
keywords = "Chemotherapy, Induction treatment, Small cell lung cancer, Surgery",
author = "Giulia Veronesi and Paolo Scanagatta and Francesco Leo and {De Pas}, Tommaso and Giuseppe Pelosi and Gianpiero Catalano and Sara Gandini and {De Braud}, Filippo and Lorenzo Spaggiari",
year = "2007",
month = "2",
language = "English",
volume = "2",
pages = "131--134",
journal = "Journal of Thoracic Oncology",
issn = "1556-0864",
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number = "2",

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TY - JOUR

T1 - Adjuvant surgery after carboplatin and VP16 in resectable small cell lung cancer

AU - Veronesi, Giulia

AU - Scanagatta, Paolo

AU - Leo, Francesco

AU - De Pas, Tommaso

AU - Pelosi, Giuseppe

AU - Catalano, Gianpiero

AU - Gandini, Sara

AU - De Braud, Filippo

AU - Spaggiari, Lorenzo

PY - 2007/2

Y1 - 2007/2

N2 - INTRODUCTION: The real benefit of surgical treatment of small cell lung cancer (SCLC) has never been demonstrated, mainly because of the rarity of surgical cases and the difficulty in comparing surgical and medical series for the different classifications systems used by surgeons (tumor, node, metastasis) and medical oncologists and radiotherapists (Veterans Administrations Lung Cancer Study Group). MATERIALS AND METHODS: We prospectively assessed the utility of surgery after chemotherapy (carboplatin plus VP16 with or without ifosfamide) with or without radiotherapy in 23 patients with preoperative diagnosis of resectable stage I to IIIA SCLC. A median of three (range: three to six) courses of chemotherapy were administered. Five pneumonectomies, 12 lobectomies (seven sleeve resections), and two segmentectomies were performed, and all except one received radical lymph node dissection. Four (17%) patients received exploratory thoracotomy. Nine (39%) patients received postoperative thoracic radiotherapy. RESULTS: Pathological stages were complete response in four patients, stage I in seven patients, stage II in seven patients, and stage III in five patients. Thirty-day morbidity and mortality were 9% and 0%, respectively. Surgery-related mortality at 90 days was 9%. Median follow-up was 19 months. Overall and local relapse rates were 52% and 17%, respectively. Median overall and disease-free survival were 24 and 12 months. Patients with complete response or pathological stage I had a significantly better Kaplan-Meier survival and lower incidence of relapse than those with more advanced pathological stage (p = 0.025 and 0.027, respectively, log rank). CONCLUSIONS: Survival after chemotherapy and surgery in the series correlated with pathological but not pretreatment stage. Only patients with pathological stage 0 or I disease seem to benefit from surgical resection.

AB - INTRODUCTION: The real benefit of surgical treatment of small cell lung cancer (SCLC) has never been demonstrated, mainly because of the rarity of surgical cases and the difficulty in comparing surgical and medical series for the different classifications systems used by surgeons (tumor, node, metastasis) and medical oncologists and radiotherapists (Veterans Administrations Lung Cancer Study Group). MATERIALS AND METHODS: We prospectively assessed the utility of surgery after chemotherapy (carboplatin plus VP16 with or without ifosfamide) with or without radiotherapy in 23 patients with preoperative diagnosis of resectable stage I to IIIA SCLC. A median of three (range: three to six) courses of chemotherapy were administered. Five pneumonectomies, 12 lobectomies (seven sleeve resections), and two segmentectomies were performed, and all except one received radical lymph node dissection. Four (17%) patients received exploratory thoracotomy. Nine (39%) patients received postoperative thoracic radiotherapy. RESULTS: Pathological stages were complete response in four patients, stage I in seven patients, stage II in seven patients, and stage III in five patients. Thirty-day morbidity and mortality were 9% and 0%, respectively. Surgery-related mortality at 90 days was 9%. Median follow-up was 19 months. Overall and local relapse rates were 52% and 17%, respectively. Median overall and disease-free survival were 24 and 12 months. Patients with complete response or pathological stage I had a significantly better Kaplan-Meier survival and lower incidence of relapse than those with more advanced pathological stage (p = 0.025 and 0.027, respectively, log rank). CONCLUSIONS: Survival after chemotherapy and surgery in the series correlated with pathological but not pretreatment stage. Only patients with pathological stage 0 or I disease seem to benefit from surgical resection.

KW - Chemotherapy

KW - Induction treatment

KW - Small cell lung cancer

KW - Surgery

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