title: Long-Term Outcomes and Patterns of Failure After Surgical Resection of Small-Cell Lung Cancer.
abstract: BACKGROUND
  The role of surgical resection as a treatment option for early-stage small-cell lung cancer (SCLC) is controversial, and few data exist regarding the patterns of treatment failure in these patients.
  
  
  METHODS
  The medical records of all patients receiving definitive surgical management of SCLC at Mayo Clinic (Rochester, MN) from January 1, 1985 to December 31, 2012 were reviewed. Estimates of survival and recurrence risk were recorded using the Kaplan-Meier method, and comparative analyses were performed with Cox regression analysis.
  
  
  RESULTS
  A total of 54 patients were identified. The median follow-up period was 5.9 years. At 5 years, overall survival was 37% and recurrence-free survival 44%. Intrathoracic recurrence, the most frequent treatment failure, occurred in 14 patients, with an estimated intrathoracic recurrence-free survival at 3 years of 64.4%. Patients undergoing wedge resection or segmentectomy, rather than lobectomy or pneumonectomy, had an increased risk of intrathoracic recurrence (hazard ratio, 3.5; P = .01). Overall survival was improved at 5 years after lobectomy or pneumonectomy compared with wedge resection or segmentectomy (48% vs. 15%, respectively; P = .03).
  
  
  CONCLUSIONS
  Surgical resection of SCLC can achieve reasonable treatment outcomes and can be considered for well-selected patients with clinical early-stage disease. Intrathoracic recurrence is the most common site of treatment failure. Caution should be taken with patients who are unable to tolerate at least lobectomy, because they are at a high risk of local recurrence.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Stish
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hallemeier
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Olivier
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: Department of General Thoracic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN. Electronic address: garces.yolanda@mayo.edu.
authors.forename: Yolanda I
authors.initials: YI
authors.lastname: Garces
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Adjuvant/neoadjuvant therapy; Lobectomy; Lung cancer surgery; Segmentectomy; Wedge resection