A PILOT PHASE-2 STUDY OF SURGICAL-TREATMENT AFTER INDUCTION CHEMOTHERAPY FOR RESECTABLE STAGE-I TO IIIA SMALL-CELL LUNG-CANCER

Background: To evaluate the feasibility and efficacy of surgical resec tion of the primary tumor and regional lymph nodes in patients with re sectable stage I to IIIA small cell lung cancer (SCLC) who had respond ed to induction chemotherapy. Methods and results: Twenty-two patients (age, 39 to 70 years; median, 60.5 years) with resectable stage I to IIIA SCLC were identified as candidates for induction chemotherapy. Al l patients received two to four cycles of preoperative chemotherapy IV every 3 weeks (CAV II: cisplatin, 80 mg/m(2), day 1; doxorubicin hydr ochloride (Adriamycin), 30 mg/m(2), day 1; etoposide (VePesid), 60 mg/ m(2) day 1 to 5). The overall response rate to induction chemotherapy was 95.5% (complete response, 5 of 22; and partial response, 16 of 22) . After induction chemotherapy, 21 patients (95.5%) underwent a surgic al resection (one pneumonectomy, 19 lobectomies, one segmentectomy). T he postoperative pathologic study revealed only SCLC in 15 patients, o nly adenocarcinoma in one patient, and no residual tumor in five patie nts. The median survival time was 61.9 months for both the 21 surgical patients and all 22 patients, while their actuarial S-year survival r ates were 66.7% and 63.6%, respectively, for a follow-up period from 4 1.1 to 107.6 months (median, 59.8 months). Patients with clinical stag es I and II disease had significantly longer survival times than did t hose with stage IIIA disease (3-year survival rates, 73.3% and 42.9%, respectively; p=0.018). The major adverse reaction was an operation-re lated death for one patient with N2 disease, but no other serious side effects were observed. Conclusion: This induction chemotherapy follow ed by surgery is feasible and may be beneficial for the treatment of r esectable stage I to IIIA SCLC.