PURPOSE: SCLC is characterized by its very early presence of metastasis and local progression. Response to chemotherapy is very good, but the rate of long-term responders is also very low. Generally, surgery is not advisable in the context of the current treatment but - as in other types of lung tumors - the question arises because of the good results in good indications. Our purpose has been to analyze the outcomes of patients diagnosed of SCLC and treated with chemo-radiotherapy and any surgical approach.
METHODS: 16 patients underwent surgery for SCLC with curative intention in the context of a multidisciplinary treatment (November 1996, November 2009). Mean age: 58 years old (41-76). 15 men and 1 woman. Indications for surgery were: first treatment in a pulmonary mass in 6 patients, rescue surgery after induction chemo and/or radiotherapy in 6 patients, and long-term local recurrence after treatment in 4 recent cases. All the patients received chemotherapy, local radiotherapy and prophylactic cranial irradiation in a multidisciplinary approach.
RESULTS: Operations performed: lobectomy (5 patients), pneumonectomy (3), wedge resection or segmentectomy (4), exploratory thoracotomy with biopsy of a hilar mass (2) (12.5%) and implantation of radioactive seeds (2). Intra-operative radiotherapy was administered in 3 cases. Postoperative complications: 1 re-operation due to postoperative bleeding, 1 postoperative pneumonia, 2 atrial fibrillations, 2 prolonged air-leaks (more than 7 days); 2 neurological syndromes (one of them probably secondary to intolerance to anti-fungus therapy); 2 patients had a postoperative pulmonary distress syndrome, and one of them died in the first postoperative month (6.3% mortality). Pathological findings were: only fibrosis in the specimen (pT0) (5 patients) (31.3%), SCLC in 8, and a mixed histology in 3. Overall survival was 45.1% and 22.6% after 5 and 10 years respectively using the Kaplan-Meier method. Median: 58 months (CI 90%: 28.4 - 88.6).
CONCLUSIONS: Pulmonary resection is associated with long-term survival in early stage SCLC and stable disease after treatment. Although morbidity is important, mortality is reasonable.
CLINICAL IMPLICATIONS: Surgery should be considered in selected patients in the context of multidisciplinary treatment
DISCLOSURE: The following authors have nothing to disclose: Wenceslao Torre, Akiko Tamura, Alfonso Gurpide, Jose Luis Perez Gracia, Ignacio Gil Bazo, Jose Lopez Picazo
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