Study: Surgery without radiotherapy may benefit certain small cell lung cancer patients

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Surgery without subsequent radiotherapy offered reasonable overall survival outcomes for patients suffering from stage I small cell lung cancer (SCLC), according to the results of a recent study published in the February edition of the Journal of Thoracic Oncology.

Lead author James B. Yu, MD, of Yale University in New Haven, Conn., and colleagues wrote that the typical treatment of SCLC involves chemotherapy and radiotherapy for limited-stage disease. However, the researchers hypothesized that the clinical outcomes for SCLC may be improved when lung-removal surgery alone is utilized instead of radiotherapy and surgery.

The retrospective study utilized the National Cancer Institute Surveillance Epidemiology and End Results (SEER) database to evaluate the outcomes for patients with SCLC treated from 1988 to 2004.  Of this sample, patients with an average age of 70 years presenting with stage I disease were selected for further evaluation.

Within this cohort, 247 stage I SCLC patients underwent lobectomies. Of this patient group, the individuals were further divided into those who had received radiotherapy following surgery (38 individuals, 15 percent) and those that had not undergone radiotherapy (205 individuals, 83 percent). The use of radiotherapy was unknown in the remaining 2 percent of the population.

In the cohort that did not receive subsequent radiotherapy, patients had a 58.1 percent survival rate at the three-year follow-up mark and a 50.3 percent rate after five years. The cohort that underwent radiotherapy following  surgery presented had 64.9 percent and 57.1 percent survival rates at the three and five-year follow-up periods, respectively.

While the authors wrote that for some patients, surgery without subsequent radiotherapy may offer a reasonable rate of survival, this practice cannot be validated across all patient cases.

"We cannot say conclusively whether patients who endure invasive surgeries can go without additional adjuvant radiation or chemotherapy,” concluded Yu and colleagues. “But looking forward, the study findings create a platform for advancing the understanding of the role of surgery in therapy.”