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Korean J Thorac Cardiovasc Surg 2012; 45(1): 40-44

Published online February 7, 2012 https://doi.org/10.5090/kjtcs.2012.45.1.40

Copyright © Journal of Chest Surgery.

Surgical Outcomes in Small Cell Lung Cancer

Min Ho Ju, M.D., Hyeong Ryul Kim, M.D.*, Joon-Bum Kim, M.D., Yong Hee Kim, M.D., Dong Kwan Kim, M.D., and Seung-Il Park, M.D.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.

Correspondence to:Corresponding author: Hyeong Ryul Kim, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. (Tel) 82-2-3010-3590, (Fax) 82-2-3010-6966, scena@dreamwiz.com

Received: July 4, 2011; Revised: October 23, 2011; Accepted: November 11, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background

The experience of a single-institution regarding surgery for small cell lung cancer (SCLC) was reviewed to evaluate the surgical outcomes and prognoses.

Materials and Methods

From July 1990 to December 2009, thirty-four patients (28 male) underwent major pulmonary resection and lymph node dissection for SCLC. Lobectomy was performed in 24 patients, pneumonectomy in eight, bilobectomy in one, and segmentectomy in one. Surgical complications, mortality, the disease-free survival (DFS) rate, and the overall survival rate were analyzed retrospectively.

Results

The median follow-up period was 26 months (range, 4 to 241 months), and there was one surgical mortality (2.9%). Six patients (17.6%) experienced recurrence, all of which were systemic. Eight patients died during follow-up; four died of disease progression and the other four died of pneumonia or of another non-cancerous cause. The three-year DFS rate was 79.2±2.6% and the overall survival rate was 66.4±10.5%. Recurrence or death was significantly prevalent in the patients with lymph node metastasis (p=0.001) as well as in those who did not undergo adjuvant chemotherapy (p=0.008). The three-year survival rate was significantly greater in the patients with pathologic stage I/II cancer than in those with stage III cancer (84% vs. 13%, p=0.001).

Conclusion

Major pulmonary resection for small cell lung cancer is feasible in selected patients. Patients with pathologic stage I or II disease showed an excellent survival rate after surgery and adjuvant treatment. Prospective randomized studies will be needed to define the role of surgery in early-stage small cell lung cancer.

Keywords: Lung neoplasms, Lung surgery, Carcinoma, oat cell

Small cell lung cancer (SCLC) has a poor prognosis because of its rapid growth rate and early metastatic dissemination [1,2]. In general, systemic chemotherapy, with or without radiotherapy, has been recommended as the appropriate therapy, and surgery has had only a limited role [3]. Pulmonary resection has been used as part of a combination therapy [4,5] or for residual lesions following concurrent chemoradiotherapy (CCRT). Pulmonary resection has also been used for mixed type lesions with non-small cell lung cancer (NSCLC). There have only been a few reports regarding surgical outcomes in patients with SCLC [6-9]. Surgery does have an established role for treating SCLC. We investigated the outcomes and risk factors of surgery in the patients from a single institution who underwent major pulmonary resection for SCLC within the past 20 years.

A total of 3,194 patients underwent major pulmonary resection for malignant neoplasm at our institution from April 1990 to December 2009. A pathology review confirmed SCLC in 34 of these patients (0.01%). The pulmonary resections were performed via a posterolateral thoracotomy (n=31) or video-assisted thoracoscopic surgery (VATS) (n=3). Mediastinal lymph node dissections were routinely performed, and all patients who had any component of SCLC seen on histology were included in this study. The Kaplan-Meier analysis was used to plot the survival curves and the rates of freedom from recurrence as well as to compare the survival rates between stage I and II, and stage III disease. Univariate Cox regression analyses were used for risk factor analysis of death or disease recurrence. Statistical analyses were performed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was defined as a 2-sided p-value ≤0.05. This study was conducted using a retrospective chart review. The seventh edition of the American Joint Committee on Cancer (AJCC) Cancer Staging was used for the stage classification.

1) Patient characteristics

A total of 34 patients with SCLC underwent major pulmonary resection. There were 28 males (82.4%) and six females (17.6%), and the mean age was 64 years (range, 44 to 76 years). Three patients underwent neoadjuvant chemotherapy. Lobectomy was performed in 24 patients (70.6%), and pneumonectomy was performed in 8 patients (23.5%). A segmentectomy and bilobectomy were both performed in one patient (2.9%) (Table 1). Mediastinoscopic lymph node dissection followed by lobectomy using VATS was performed on three patients. The other thirty-one patients underwent posterolateral thoracotomy.

2) Surgical outcomes

There was one case of surgical mortality (2.9%). This patient died of sudden cardiac arrest, and the cause of shock was thought to be bleeding at the pneumonectomy site. There were no major postoperative complications in any of the other cases.

Pure SCLC was confirmed in 24 patients (70.6%), and mixed type tumors with NSCLC was confirmed in 10 patients (29.4%) on the postoperative histological examination. Squamous cell lung cancer was most often accompanied by a mixed histology (n=4, 11.8%). Twenty-six patients had pathologic stage I or II disease, and eight patients had stage III disease (Table 1).

Thirty patients (88.2%) received adjuvant therapy. Nineteen patients (55.9%) received only radio-therapy. Ten patients (29.4%) received CCRT, and one patient (2.9%) received only chemotherapy. Adjuvant therapy was not performed in three patients because of either their poor general condition or other complications (Table 2).

The median follow-up period was 26 months (range, 4 to 241 months). There were eight late deaths (26.5%) during the follow-up period; four died of disease progression and the other four died of pneumonia or another non-cancerous cause. The cancer recurred in six cases (17.6%), which were all systemic recurrences (Table 3).

In this study, the overall five-year survival rate was 66.4% (Fig. 1) and the three-year disease-free survival rate was 79.2% (Fig. 2). The three-year survival rate according to the pathologic stage was 84% in patients with stage I and II disease and 13% in patients with stage III disease (p=0.001) (Fig. 3).

3) Risk factors for death or recurrence

The risk factors for death or disease recurrence were analyzed using the univariate Cox-regression hazard model. As the number of the deaths and patients with disease recurrence was too small for statistical analysis, we analyzed the risk factors for death or disease recurrence. Lymph node metastasis (p=0.001) and the absence of adjuvant chemotherapy (p=0.008) were shown to be risk factors for death or recurrence (Table 4).

In general, the role of surgery in SCLC is limited as SCLC is usually treated using chemotherapy or CCRT [3,10]. The important role of chemotherapy in SCLC has been well-established by clinical trials [9,11,12]. Despite the development of new chemotherapeutic agents for decades, SCLC remains a disease with a high mortality rate and a low cure rate, even in limited stage groups [11]. Despite their initial responses to therapy, most patients with SCLC develop local recurrence [12].

There have been some previous reports regarding the role of surgery and its outcome in patients with SCLC. Shah et al. [13] reported that the five-year survival rate was 43% when treated with only surgery in 28 patients with SCLC. Schreiber et al. [14] indicated that the use of surgery, particularly lobectomy, was associated with favorable survival outcomes. There were other reports regarding the surgical outcome using adjuvant therapies [1,15-17]. In these reports, in the majority of cases, the use of surgery as part of multimodality therapy had more successful outcomes than those of conventional therapies. As seen in previous reports, current CCRT protocols have demonstrated local failure rates of approximately 50% [18]. Complete surgical resection after induction CCRT has shown control of local relapse in almost 100% [19]. This was particularly noticeable in the early stage groups (T1-2, N0, M0). In our study, 84% of the stage I and II group and 13% of the stage III group patients showed a three-year survival rate. Histologically mixed tumors with both SCLC and NSCLC components may fail to meet CCRT protocol requirements since there is less sensitivity of the NSCLC component to chemotherapy. It has been shown that the final histological findings for tumors that were initially reported as SCLC indicated that they contained NSCLC components in 11% to 25% of patients [20]. In our study, 29.4% of the patients had NSCLC components according to the pathology review.

Overall, the five-year patient survival rate was 66.4% in this study. Lymph node metastasis and the absence of adjuvant chemotherapy were risk factors for patient death or tumor recurrence. Our study had some limitations. It was a retrospective investigation with only a small number of subjects. Despite these factors, according to our study results, major pulmonary resection for SCLC was feasible in selected patients. Prospective, randomized studies will be needed to determine the role of surgery in early-stage SCLC.

Go to Figures
Fig. 1.Overall survival rate determined using the Kaplan-Meier method. The overall survival rate was 66.4±10.5% at five years after surgery.
Fig. 2.Freedom from recurrence rate after surgical resection, determined using the Kaplan-Meier method. The freedom from recurrence rate was 79.2±2.6% at five years after surgery.
Fig. 3.Comparison of the survival rates in the stage I, II, and III groups. The stage I and II groups showed a significantly higher survival rate than the stage III group (p=0.001).

Table 1
Patient characteristics (n=34)

Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.


Table 2
Treatment combined with surgical resection in patients with small cell lung cancer

Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.


Table 3
Surgical outcomes for patients with small cell lung cancer

Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.


Table 4
Risk factor analysis for death or disease recurrence

Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.

  1. Chung KY, Hong GP, Kim KD, Kim DJ, Kim JH. Surgical resection of small cell lung cancer (SCLC). Korean J Thorac Cardiovasc Surg 1998;31:1195-9.
  2. Ichinose Y, Hara N, Ohta M, Takamori S, Kawasaki M, Hata K. Comparison between resected and irradiated small cell lung cancer in patients in stages I through IIIa. Ann Thorac Surg 1992;53:95-100.
    CrossRef
  3. Jackman DM, Johnson BE. Small-cell lung cancer. Lancet 2005;366:1385-96.
    CrossRef
  4. Kohman LJ. Is there a place for surgery in central small cell lung cancer? Chest Surg Clin N Am 1997;7:105-12.
    Pubmed
  5. Meyer JA, Comis RL, Ginsberg SJ, et al. Phase II trial of extended indications for resection is small cell carcinoma of the lung. J Thorac Cardiovasc Surg 1982;83:12-9.
    Pubmed
  6. Warde P, Payne D. Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 1992;10:890-5.
    Pubmed
  7. Shields TW, Higgins GA Jr, Matthews MJ, Keehn RJ. Surgical resection in the management of small cell carcinoma of the lung. J Thorac Cardiovasc Surg 1982;84:481-8.
    Pubmed
  8. Inoue M, Miyoshi S, Yasumitsu T, et al. Surgical results for small cell lung cancer based on the new TNM staging system. Thoracic Surgery Study Group of Osaka University, Osaka, Japan. Ann Thorac Surg 2000;70:1615-9.
    CrossRef
  9. Shepherd FA, Ginsberg RJ, Patterson GA, Evans WK, Feld R. A prospective study of adjuvant surgical resection after chemotherapy for limited small cell lung cancer: a University of Toronto Lung Oncology Group study. J Thorac Cardiovasc Surg 1989;97:177-86.
    Pubmed
  10. Mountain CF. Clinical biology of small cell carcinoma: relationship to surgical therapy. Semin Oncol 1978;5:272-9.
    Pubmed
  11. Shepherd FA, Ginsberg RJ, Feld R, Evans WK, Johansen E. Surgical treatment for limited small-cell lung cancer. The University of Toronto Lung Oncology Group experience. J Thorac Cardiovasc Surg 1991;101:385-93.
    Pubmed
  12. Elliott JA, Osterlind K, Hirsch FR, Hansen HH. Metastatic patterns in small-cell lung cancer: correlation of autopsy findings with clinical parameters in 537 patients. J Clin Oncol 1987;5:246-54.
    Pubmed
  13. Shah SS, Thompson J, Goldstraw P. Results of operation without adjuvant therapy in the treatment of small cell lung cancer. Ann Thorac Surg 1992;54:498-501.
    CrossRef
  14. Schreiber D, Rineer J, Weedon J, et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer:should its role be re-evaluated? Cancer 2010;116:13507.
    Pubmed CrossRef
  15. Coolen L, Van den Eeckhout A, Deneffe G, Demedts M, Vansteenkiste J. Surgical treatment of small cell lung cancer. Eur J Cardiothorac Surg 1995;9:59-64.
    CrossRef
  16. Meyer JA, Comis RL, Ginsberg SJ, et al. The prospect of disease control by surgery combined with chemotherapy in stage I and stage II small cell carcinoma of the lung. Ann Thorac Surg 1983;36:37-41.
    CrossRef
  17. Ulsperger E, Karrer K, Denck H. Multimodality treatment for small cell bronchial carcinoma. Preliminary results of a prospective, multicenter trial. The ISC-Lung Cancer Study Group. Eur J Cardiothorac Surg 1991;5:306-9.
    CrossRef
  18. Turrisi AT 3rd, Kim K, Blum R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 1999;340:265-71.
    Pubmed CrossRef
  19. Eberhardt W, Korfee S. New approaches for small-cell lung cancer: local treatments. Cancer Control 2003;10:289-96.
  20. Asamura H, Kameya T, Matsuno Y, et al. Neuroendocrine neoplasms of the lung: a prognostic spectrum. J Clin Oncol 2006;24:70-6.
    Pubmed CrossRef

Article

Clinical Research

Korean J Thorac Cardiovasc Surg 2012; 45(1): 40-44

Published online February 7, 2012 https://doi.org/10.5090/kjtcs.2012.45.1.40

Copyright © Journal of Chest Surgery.

Surgical Outcomes in Small Cell Lung Cancer

Min Ho Ju, M.D., Hyeong Ryul Kim, M.D.*, Joon-Bum Kim, M.D., Yong Hee Kim, M.D., Dong Kwan Kim, M.D., and Seung-Il Park, M.D.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.

Correspondence to:Corresponding author: Hyeong Ryul Kim, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. (Tel) 82-2-3010-3590, (Fax) 82-2-3010-6966, scena@dreamwiz.com

Received: July 4, 2011; Revised: October 23, 2011; Accepted: November 11, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The experience of a single-institution regarding surgery for small cell lung cancer (SCLC) was reviewed to evaluate the surgical outcomes and prognoses.

Materials and Methods

From July 1990 to December 2009, thirty-four patients (28 male) underwent major pulmonary resection and lymph node dissection for SCLC. Lobectomy was performed in 24 patients, pneumonectomy in eight, bilobectomy in one, and segmentectomy in one. Surgical complications, mortality, the disease-free survival (DFS) rate, and the overall survival rate were analyzed retrospectively.

Results

The median follow-up period was 26 months (range, 4 to 241 months), and there was one surgical mortality (2.9%). Six patients (17.6%) experienced recurrence, all of which were systemic. Eight patients died during follow-up; four died of disease progression and the other four died of pneumonia or of another non-cancerous cause. The three-year DFS rate was 79.2±2.6% and the overall survival rate was 66.4±10.5%. Recurrence or death was significantly prevalent in the patients with lymph node metastasis (p=0.001) as well as in those who did not undergo adjuvant chemotherapy (p=0.008). The three-year survival rate was significantly greater in the patients with pathologic stage I/II cancer than in those with stage III cancer (84% vs. 13%, p=0.001).

Conclusion

Major pulmonary resection for small cell lung cancer is feasible in selected patients. Patients with pathologic stage I or II disease showed an excellent survival rate after surgery and adjuvant treatment. Prospective randomized studies will be needed to define the role of surgery in early-stage small cell lung cancer.

Keywords: Lung neoplasms, Lung surgery, Carcinoma, oat cell

INTRODUCTION

Small cell lung cancer (SCLC) has a poor prognosis because of its rapid growth rate and early metastatic dissemination [1,2]. In general, systemic chemotherapy, with or without radiotherapy, has been recommended as the appropriate therapy, and surgery has had only a limited role [3]. Pulmonary resection has been used as part of a combination therapy [4,5] or for residual lesions following concurrent chemoradiotherapy (CCRT). Pulmonary resection has also been used for mixed type lesions with non-small cell lung cancer (NSCLC). There have only been a few reports regarding surgical outcomes in patients with SCLC [6-9]. Surgery does have an established role for treating SCLC. We investigated the outcomes and risk factors of surgery in the patients from a single institution who underwent major pulmonary resection for SCLC within the past 20 years.

MATERIALS AND METHODS

A total of 3,194 patients underwent major pulmonary resection for malignant neoplasm at our institution from April 1990 to December 2009. A pathology review confirmed SCLC in 34 of these patients (0.01%). The pulmonary resections were performed via a posterolateral thoracotomy (n=31) or video-assisted thoracoscopic surgery (VATS) (n=3). Mediastinal lymph node dissections were routinely performed, and all patients who had any component of SCLC seen on histology were included in this study. The Kaplan-Meier analysis was used to plot the survival curves and the rates of freedom from recurrence as well as to compare the survival rates between stage I and II, and stage III disease. Univariate Cox regression analyses were used for risk factor analysis of death or disease recurrence. Statistical analyses were performed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was defined as a 2-sided p-value ≤0.05. This study was conducted using a retrospective chart review. The seventh edition of the American Joint Committee on Cancer (AJCC) Cancer Staging was used for the stage classification.

RESULTS

1) Patient characteristics

A total of 34 patients with SCLC underwent major pulmonary resection. There were 28 males (82.4%) and six females (17.6%), and the mean age was 64 years (range, 44 to 76 years). Three patients underwent neoadjuvant chemotherapy. Lobectomy was performed in 24 patients (70.6%), and pneumonectomy was performed in 8 patients (23.5%). A segmentectomy and bilobectomy were both performed in one patient (2.9%) (Table 1). Mediastinoscopic lymph node dissection followed by lobectomy using VATS was performed on three patients. The other thirty-one patients underwent posterolateral thoracotomy.

2) Surgical outcomes

There was one case of surgical mortality (2.9%). This patient died of sudden cardiac arrest, and the cause of shock was thought to be bleeding at the pneumonectomy site. There were no major postoperative complications in any of the other cases.

Pure SCLC was confirmed in 24 patients (70.6%), and mixed type tumors with NSCLC was confirmed in 10 patients (29.4%) on the postoperative histological examination. Squamous cell lung cancer was most often accompanied by a mixed histology (n=4, 11.8%). Twenty-six patients had pathologic stage I or II disease, and eight patients had stage III disease (Table 1).

Thirty patients (88.2%) received adjuvant therapy. Nineteen patients (55.9%) received only radio-therapy. Ten patients (29.4%) received CCRT, and one patient (2.9%) received only chemotherapy. Adjuvant therapy was not performed in three patients because of either their poor general condition or other complications (Table 2).

The median follow-up period was 26 months (range, 4 to 241 months). There were eight late deaths (26.5%) during the follow-up period; four died of disease progression and the other four died of pneumonia or another non-cancerous cause. The cancer recurred in six cases (17.6%), which were all systemic recurrences (Table 3).

In this study, the overall five-year survival rate was 66.4% (Fig. 1) and the three-year disease-free survival rate was 79.2% (Fig. 2). The three-year survival rate according to the pathologic stage was 84% in patients with stage I and II disease and 13% in patients with stage III disease (p=0.001) (Fig. 3).

3) Risk factors for death or recurrence

The risk factors for death or disease recurrence were analyzed using the univariate Cox-regression hazard model. As the number of the deaths and patients with disease recurrence was too small for statistical analysis, we analyzed the risk factors for death or disease recurrence. Lymph node metastasis (p=0.001) and the absence of adjuvant chemotherapy (p=0.008) were shown to be risk factors for death or recurrence (Table 4).

DISCUSSION

In general, the role of surgery in SCLC is limited as SCLC is usually treated using chemotherapy or CCRT [3,10]. The important role of chemotherapy in SCLC has been well-established by clinical trials [9,11,12]. Despite the development of new chemotherapeutic agents for decades, SCLC remains a disease with a high mortality rate and a low cure rate, even in limited stage groups [11]. Despite their initial responses to therapy, most patients with SCLC develop local recurrence [12].

There have been some previous reports regarding the role of surgery and its outcome in patients with SCLC. Shah et al. [13] reported that the five-year survival rate was 43% when treated with only surgery in 28 patients with SCLC. Schreiber et al. [14] indicated that the use of surgery, particularly lobectomy, was associated with favorable survival outcomes. There were other reports regarding the surgical outcome using adjuvant therapies [1,15-17]. In these reports, in the majority of cases, the use of surgery as part of multimodality therapy had more successful outcomes than those of conventional therapies. As seen in previous reports, current CCRT protocols have demonstrated local failure rates of approximately 50% [18]. Complete surgical resection after induction CCRT has shown control of local relapse in almost 100% [19]. This was particularly noticeable in the early stage groups (T1-2, N0, M0). In our study, 84% of the stage I and II group and 13% of the stage III group patients showed a three-year survival rate. Histologically mixed tumors with both SCLC and NSCLC components may fail to meet CCRT protocol requirements since there is less sensitivity of the NSCLC component to chemotherapy. It has been shown that the final histological findings for tumors that were initially reported as SCLC indicated that they contained NSCLC components in 11% to 25% of patients [20]. In our study, 29.4% of the patients had NSCLC components according to the pathology review.

CONCLUSION

Overall, the five-year patient survival rate was 66.4% in this study. Lymph node metastasis and the absence of adjuvant chemotherapy were risk factors for patient death or tumor recurrence. Our study had some limitations. It was a retrospective investigation with only a small number of subjects. Despite these factors, according to our study results, major pulmonary resection for SCLC was feasible in selected patients. Prospective, randomized studies will be needed to determine the role of surgery in early-stage SCLC.

Fig 1.

Figure 1.Overall survival rate determined using the Kaplan-Meier method. The overall survival rate was 66.4±10.5% at five years after surgery.
Journal of Chest Surgery 2012; 45: 40-44https://doi.org/10.5090/kjtcs.2012.45.1.40

Fig 2.

Figure 2.Freedom from recurrence rate after surgical resection, determined using the Kaplan-Meier method. The freedom from recurrence rate was 79.2±2.6% at five years after surgery.
Journal of Chest Surgery 2012; 45: 40-44https://doi.org/10.5090/kjtcs.2012.45.1.40

Fig 3.

Figure 3.Comparison of the survival rates in the stage I, II, and III groups. The stage I and II groups showed a significantly higher survival rate than the stage III group (p=0.001).
Journal of Chest Surgery 2012; 45: 40-44https://doi.org/10.5090/kjtcs.2012.45.1.40
Patient characteristics (n=34)|@|Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.

Treatment combined with surgical resection in patients with small cell lung cancer|@|Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.

Surgical outcomes for patients with small cell lung cancer|@|Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.

Risk factor analysis for death or disease recurrence|@|Values are presented as mean±standard deviation or number (%). SCLC=small cell lung cancer.

*Major pulmonary resection with surrounding tissues, i.e., chest wall, rib, pericardium, diaphragm, etc.

References

  1. Chung KY, Hong GP, Kim KD, Kim DJ, Kim JH. Surgical resection of small cell lung cancer (SCLC). Korean J Thorac Cardiovasc Surg 1998;31:1195-9.
  2. Ichinose Y, Hara N, Ohta M, Takamori S, Kawasaki M, Hata K. Comparison between resected and irradiated small cell lung cancer in patients in stages I through IIIa. Ann Thorac Surg 1992;53:95-100.
    CrossRef
  3. Jackman DM, Johnson BE. Small-cell lung cancer. Lancet 2005;366:1385-96.
    CrossRef
  4. Kohman LJ. Is there a place for surgery in central small cell lung cancer? Chest Surg Clin N Am 1997;7:105-12.
    Pubmed
  5. Meyer JA, Comis RL, Ginsberg SJ, et al. Phase II trial of extended indications for resection is small cell carcinoma of the lung. J Thorac Cardiovasc Surg 1982;83:12-9.
    Pubmed
  6. Warde P, Payne D. Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 1992;10:890-5.
    Pubmed
  7. Shields TW, Higgins GA Jr, Matthews MJ, Keehn RJ. Surgical resection in the management of small cell carcinoma of the lung. J Thorac Cardiovasc Surg 1982;84:481-8.
    Pubmed
  8. Inoue M, Miyoshi S, Yasumitsu T, et al. Surgical results for small cell lung cancer based on the new TNM staging system. Thoracic Surgery Study Group of Osaka University, Osaka, Japan. Ann Thorac Surg 2000;70:1615-9.
    CrossRef
  9. Shepherd FA, Ginsberg RJ, Patterson GA, Evans WK, Feld R. A prospective study of adjuvant surgical resection after chemotherapy for limited small cell lung cancer: a University of Toronto Lung Oncology Group study. J Thorac Cardiovasc Surg 1989;97:177-86.
    Pubmed
  10. Mountain CF. Clinical biology of small cell carcinoma: relationship to surgical therapy. Semin Oncol 1978;5:272-9.
    Pubmed
  11. Shepherd FA, Ginsberg RJ, Feld R, Evans WK, Johansen E. Surgical treatment for limited small-cell lung cancer. The University of Toronto Lung Oncology Group experience. J Thorac Cardiovasc Surg 1991;101:385-93.
    Pubmed
  12. Elliott JA, Osterlind K, Hirsch FR, Hansen HH. Metastatic patterns in small-cell lung cancer: correlation of autopsy findings with clinical parameters in 537 patients. J Clin Oncol 1987;5:246-54.
    Pubmed
  13. Shah SS, Thompson J, Goldstraw P. Results of operation without adjuvant therapy in the treatment of small cell lung cancer. Ann Thorac Surg 1992;54:498-501.
    CrossRef
  14. Schreiber D, Rineer J, Weedon J, et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer:should its role be re-evaluated? Cancer 2010;116:13507.
    Pubmed CrossRef
  15. Coolen L, Van den Eeckhout A, Deneffe G, Demedts M, Vansteenkiste J. Surgical treatment of small cell lung cancer. Eur J Cardiothorac Surg 1995;9:59-64.
    CrossRef
  16. Meyer JA, Comis RL, Ginsberg SJ, et al. The prospect of disease control by surgery combined with chemotherapy in stage I and stage II small cell carcinoma of the lung. Ann Thorac Surg 1983;36:37-41.
    CrossRef
  17. Ulsperger E, Karrer K, Denck H. Multimodality treatment for small cell bronchial carcinoma. Preliminary results of a prospective, multicenter trial. The ISC-Lung Cancer Study Group. Eur J Cardiothorac Surg 1991;5:306-9.
    CrossRef
  18. Turrisi AT 3rd, Kim K, Blum R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 1999;340:265-71.
    Pubmed CrossRef
  19. Eberhardt W, Korfee S. New approaches for small-cell lung cancer: local treatments. Cancer Control 2003;10:289-96.
  20. Asamura H, Kameya T, Matsuno Y, et al. Neuroendocrine neoplasms of the lung: a prognostic spectrum. J Clin Oncol 2006;24:70-6.
    Pubmed CrossRef

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