Surgery Alone Offers Satisfactory Overall Survival in Early Small-Cell Lung Cancer

A new study has concluded that in selected patients with early stage I small-cell lung cancer (SCLC), a lobectomy offers excellent overall survival, without the need for additional treatment.

Researchers from Yale University (New Haven, CT, USA) retrospectively evaluated the outcomes of 247 stage I SCLC patients who underwent lobectomies, identified using the U.S. National Cancer Institute (Bethesda, MD, USA) Surveillance Epidemiology and End Results (SEER) database. Kaplan-Meier survival curves were constructed for overall survival (OS) and cause-specific survival for patient strata, based on type of surgery and radiation use or nonuse; the researchers assumed that all patients received systemic therapy as well.

The study's results showed that of these who had lobectomy, 205 (83%) did not receive radiation therapy (RT), 38 (15%) did receive RT, and use of RT was unknown in 4 (2%). The three- and five-year survival rates for the patient group who underwent lobectomies without RT were 58.1% and 50.3%, respectively. For those who supplemented their surgery with RT, three- and five -year overall survival was 64.9% and 57.1%, respectively. The study was published in the February 2010 edition of the Journal of Thoracic Oncology.

"Based on our analysis, surgery without RT may offer a reasonable survival in a selected cohort of patients who undergo lobectomy, but this needs to be validated in a prospective setting,” said lead author James Yu, M.D., of the department of therapeutic radiology. "We cannot say conclusively whether patients who endure invasive surgeries can go without additional adjuvant radiation or chemotherapy, but looking forward, the study findings create a platform for advancing the understanding of the role of surgery in therapy.”

Small-cell lung cancer, also called oat-cell cancer, tends to arise in the larger airways (primary and secondary bronchi) and grows rapidly, becoming quite large; it is strongly associated with smoking. The small cells contain dense neurosecretory granules--vesicles containing neuroendocrine hormones--which cause an endocrine/paraneoplastic syndrome association. While initially more sensitive to chemotherapy, it ultimately carries a worse prognosis and is often metastatic at presentation. Small-cell lung cancers are divided into limited stage and extensive stage disease.

Related Links:
Yale University
U.S. National Cancer Institute