title: Surgery in the tri-modality treatment of small cell lung cancer. Stage-dependent survival.
abstract: OBJECTIVE
  Patients with small cell lung cancer (SCLC) are frequently denied surgical treatment despite growing body of evidence for a longer duration of remission and overall survival, if surgical intervention is integrated in a tri-modality therapy concept including chemotherapy, surgery, and radiotherapy.
  
  
  METHODS
  A retrospective analysis was performed using data derived from 95 patients with SCLC operated upon over a period of 9 years. A subset of these patients was primarily operated upon and being diagnosed as SCLC only after thoracotomy, received radio-/chemotherapy postoperatively (n=64, group I). The second cohort had surgery after neoadjuvant chemotherapy which was continued postoperatively in addition to thoracic and cranial radiotherapy (n=31, group II). The patients in the second group were further divided into two subgroups: complete histological regression of tumor tissue in the mediastinal lymph nodes (group IIA), and those with persistent mediastinal lymph nodal involvement detected after thoracotomy (group IIB).
  
  
  RESULTS
  Group I patients had stage I or II disease, whereas group II patients had clinical stage IIIA or IIIB. The overall 30-day mortality rate was as low as 5%. The median survival was 31.3 months for patients in group I, 31.7 months for adjuvant surgery with complete regression of mediastinal nodes (group IIA), and 12.4 months for adjuvant surgery without regression of mediastinal nodes (group IIB).
  
  
  CONCLUSIONS
  Surgical intervention is promising and warrants prospective trials to be evaluated as an important adjunct to multi-modality therapy regimen in SCLC as regards to its impact on relapse free and overall survival.
authors.affiliation: Department of Thoracic Surgery, Evangelisches Krankenhaus Duisburg Nord, Fahrner Street 133, Duisburg 47169, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Granetzny
authors.forename: Ahmad
authors.initials: A
authors.lastname: Boseila
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wagner
authors.forename: Georg
authors.initials: G
authors.lastname: Krukemeyer
authors.forename: Ulf
authors.initials: U
authors.lastname: Vogt
authors.forename: Erich
authors.initials: E
authors.lastname: Hecker
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Koch
authors.forename: Folker
authors.initials: F
authors.lastname: Klinke
mesh_terms: D000328:Adult; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome