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Benefits of surgical resection for small cell lung cancer remain unclear
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Although surgical resection resulted in reasonable outcomes among well-chosen patients with early-stage small cell lung cancer, use of the treatment approach in this setting remains controversial, according to study results.
Intrathoracic recurrence — the most common treatment failure in the study — occurred more frequently in patients who underwent limited resections. Thus, the researchers determined additional research is needed to assess the overall efficacy of combining surgery with chemotherapy and radiation therapy.
“Small cell lung cancer (SCLC) accounts for approximately 15% of the primary lung cancer diagnoses in the United States each year,” Yolanda I. Garces, MD, of the department of radiation oncology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “The current National Comprehensive Cancer Network guidelines recommend surgical resection as the preferred first-line treatment for patients with early-stage, node-negative disease. The purpose of this study was to evaluate clinical outcomes and patterns of recurrence in a single-institution series of patients undergoing curative resection of SCLC.”
Garces and colleagues evaluated data from the department of thoracic surgery at Mayo Clinic and the Mayo Clinic Cancer Registry to identify 54 patients who underwent surgical resection for SCLC between 1985 and 2012. Median age at time of surgery was 69.3 years (range, 53-84) and 57% of the population was female.
The majority of the population had preoperative stage IA (59%) or IB (17%) disease; 11% had stage IIA disease, 6% had stage IIB disease and 7% had stage IIIA disease.
Patients underwent lobectomy (57%), wedge (30%), segmentectomy (9%) or pneumonectomy (4%) resections.
Median follow-up was 5.9 years.
Median OS was 3.1 years, and 5-year OS was 37%. Patients with clinical stage I disease achieved significantly longer median OS than patients with preoperative stage II or III disease (4.5 years vs 1.6 years; P = .04).
“Current NCCN guidelines do not recommend surgical resection for node-positive SCLC patients,” Garces and colleagues wrote. “Our data support this conclusion, because median OS was significantly decreased in patients with clinical stage II/III disease.”
Twenty-four patients experienced SCLC recurrence. Median RFS was 2.4 years, and 50% of patients achieved 3-year RFS. The majority of recurrences (88%; n = 21) occurred within 18 months of surgery, and all patients with SCLC recurrences died as a result.
Types of recurrence included intrathoracic (n = 8), distant (n = 10) or both (n = 6).
Patients who underwent limited resection — which included wedge resection or segmentectomy — were more likely than those who underwent lobectomy or pneumonectomy to experience any recurrence (HR = 3.7; P = .003) or intrathoracic recurrence (HR = 3.5; P = .01). Limited resection also was associated with an increased risk for death (HR = 2.3; P = .03).
Eighty-seven percent of patients also went adjuvant chemotherapy and 17% underwent adjuvant thoracic radiation therapy.
Results of a univariate analysis indicated adjuvant chemotherapy was associated with insignificant improvements in OS (HR = 0.49) and intrathoracic RFS (HR = 0.5). Adjuvant thoracic radiation therapy also was associated with an insignificant reduction in the risks for death (HR = 0.6) or any recurrence (HR = 0.5).
“The role of surgical resection for SCLC remains controversial, and limited data exist regarding patterns of failure in these patients,” Garces and colleagues wrote. “From these data, we recommend that patients with clinically node-positive disease be treated with chemoradiation rather than surgery. Adjuvant chemotherapy should be used in all patients after surgery, and postoperative radiation therapy should be strongly considered for those who underwent limited resection or had evidence of pathological metastases.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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