SURGICAL-TREATMENT OF SMALL-CELL CARCINOMA OF THE LUNG - ADVANTAGE OFPREOPERATIVE CHEMOTHERAPY

To assess the effect of chemotherapy on postoperative survival of pati ents with small cell lung carcinoma (SCLC), 46 patients who underwent surgery at Kyoto University between 1976 and 1991 were retrospectively reviewed. Seventeen patients (37.0%) received chemotherapy prior to a s well as after surgery (neoadjuvant therapy group), 23 (50.5%) receiv ed chemotherapy only after surgery (adjuvant therapy group), and the o ther six received no chemotherapy (non-chemotherapy group). The 5-year survival rate of patients with c-Stage I or II disease in the neoadju vant therapy group was as high as 80.0%, which seemed to be higher, al though with no statistical significance, than that in the adjuvant the rapy group (37.7%, P = 0.10). The 5-year survival rate of patients wit h c-Stage III (IIIa or IIIb) disease in the neoadjuvant therapy group, although not satisfactory (10.0%), was significantly higher than that in the adjuvant therapy group (0.0%, P=0.04). No patients in the non- chemotherapy group had survived 5 years. Moreover, multivariate analys is showed that failure to employ preoperative chemotherapy was the str ongest prognostic factor causing a poor prognosis (P = 0.01). On the o ther hand, eight (30.8%) out of 26 patients with c-Stage I or II disea se postoperatively proved to have mediastinal lymph node involvement ( pN2-3), and two (7.7%) proved to have intrapulmonary metastasis (PM). Considering the advantage of preoperative chemotherapy and the discrep ancy between c- and p-stage, sufficient chemotherapy prior to surgery should be employed, and may realize a good prognosis in patients with c-Stage I or II disease. In contrast, patients with c-Stage III diseas e are not appropriate as candidates for surgery even if preoperative c hemotherapy is performed.