Prognostically orientated multimodality treatment including surgery for selected patients of small-cell lung cancer patients stages IB to IIIB: long-term results of a phase II trial

Following mediastinoscopy, a prognostically orientated multimodality approa ch was chosen in selected small-cell lung cancer (SCLC) patients with hyper fractionated accelerated chemoradiotherapy (Hf-RTx) and definitive surgery (S). Stage IB/IIA patients had four cycles of cisplatin/etoposide (PE) and surgery. Stage IIB/IIIA patients had three cycles PE followed by one cycle concurrent chemoradiation including Hf-RTx and surgery. Most stage IIIB pat ients were not planned for surgery and had CTx followed by sequential RTx o r one cycle concurrent CTx/RTx. Of 46 consecutive patients (stage IB six, I IA two, IIB/IIIA 22, IIIB 16) 43 (94%) showed an objective response. Twenty -three of patients (72%) planned for inclusion of S were completely resecte d (RO) (IB 6/6, IIA 2/2, IIB/IIIA 13/22, IIIB 2/2). Overall toxicity was ac ceptable - one patient died of septicaemia, no perioperative deaths occurre d. Median follow-up of patients alive (n = 21) is 52 months (30+ - 75+). Me dian survival and 5-year survival rate of all patients are 36 months and 46 %, in RO patients 68 months and 63% (RO-IIB/IIIA/IIIB: not yet reached and 67%), This multimodality treatment including surgery proved highly effectiv e with 100% local control and remarkable long-term survival after complete resection, even in locally advanced SCLC stages IIB/IIIA patients, (C) 1999 Cancer Research Campaign.