A pilot phase 2 study of surgical treatment after induction chemotherapy for resectable stage I to IIIA small cell lung cancer

Background: To evaluate the feasibility and efficacy of surgical resection of the primary tumor and regional lymph nodes in patients with resectable stage I to IIIA small cell lung cancer (SCLC) who had responded to induction chemotherapy. Methods and results: Twenty-two patients (age, 39 to 70 years; median, 60.5 years) with resectable stage I to IIIA SCLC were identified as candidates for induction chemotherapy. All patients received two to four cycles of preoperative chemotherapy IV every 3 weeks (CAV II: cisplatin, 80 mg/m(2), day 1; doxorubicin hydrochloride (Adriamycin), 30 mg/m(2), day 1; etoposide (VePesid), 60 mg/m(2) day 1 to 5). The overall response rate to induction chemotherapy was 95.5% (complete response, 5 of 22; and partial response, 16 of 22). After induction chemotherapy, 21 patients (95.5%) underwent a surgical resection (one pneumonectomy, 19 lobectomies, one segmentectomy). The postoperative pathologic study revealed only SCLC in 15 patients, only adenocarcinoma in one patient, and no residual tumor in five patients. The median survival time was 61.9 months for both the 21 surgical patients and all 22 patients, while their actuarial S-year survival rates were 66.7% and 63.6%, respectively, for a follow-up period from 41.1 to 107.6 months (median, 59.8 months). Patients with clinical stages I and II disease had significantly longer survival times than did those with stage IIIA disease (3-year survival rates, 73.3% and 42.9%, respectively; p=0.018). The major adverse reaction was an operation-related death for one patient with N2 disease, but no other serious side effects were observed. Conclusion: This induction chemotherapy followed by surgery is feasible and may be beneficial for the treatment of resectable stage I to IIIA SCLC.