Long term results of surgery and chemotherapy in small cell lung cancer

Objective: The aim of the study is to analyse long-term results of patients with small cell lung cancer (SCLC) treated at the same institution accordi ng to a prospective study including surgery, chemotherapy, and radiotherapy ; Methods: From 1981 to 1995, 104 patients with a proven histology of SCLC underwent surgery, chemotherapy, and radiotherapy. Fifty-one patients with operable stage I or Il lesion received surgical resection followed by adjuv ant chemotherapy and radiotherapy. Fifty-three patients with proved SCLC an d clinical stage III received induction chemotherapy followed by surgery an d radiotherapy. All patients received from four to six courses of chemother apy and 36 had prophylactic cranial irradiation (PCI). All patients had fol low-up for at least 1 year, and survival time was calculated from the date of the diagnosis until death or most recent follow-up. Results: Ninety-six patients were male and sight female. We performed 29 pneumonectomies, eight bilobectomies, 66 lobectomies and one no resection. Regarding the clinical stage, 35 patients (33.6%) had stage I, 16 patients (15.4%) had stage II a nd 53 (51%) had stage III. Post-operative pathologic staging revealed stage I in 37 patients (35.6%), stage IT in nine patients (8.6%), stage III in 4 5 patients (43.3%), and in 13 patients (12.5%) there was no more tumor. The 30-day mortality was 2% (two patients). Fourteen patients (13.4%) had post -operative complications. Fifty-one patients (49%) had a relapse. The media n follow-up was 55 months. Twenty-six patients remain alive and 78 patients have died. The overall 5-year survival rate was 32%, with an estimate medi an survival time of 28 months; according to the pathologic stage, the survi val data were 52.2%, 30% and 15.3% for stage I, II and III, respectively (P < 0.001). The 5-year survival was 41% in patients without SCLC after chemo therapy. Conclusion: As with non-small cell lune cancer, survival following surgery and chemotherapy clearly correlates with the stage. At present, it is not clear whether surgery is truly effective for patients with SCLC. In our experience, the complete elimination of small cell lung cancer is asso ciated with an improvement in survival (41% at 5 years). (C) 1998 Elsevier Science B.V. All rights reserved.