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G. Stamatis
Moderator of
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SC25 - The Role of Surgeons in Multimodality Clinical Trials (ID 349)
- Event: WCLC 2016
- Type: Science Session
- Track: Surgery
- Presentations: 5
- Moderators:N. Ikeda, G. Stamatis
- Coordinates: 12/07/2016, 11:00 - 12:30, Strauss 2
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SC25.01 - Trial Design for Multimodality Treatment of NSCLC (ID 6705)
11:00 - 11:20 | Author(s): D. Jones
- Abstract
- Presentation
Abstract not provided
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SC25.02 - Quality of Resection in Induction and Adjuvant Clinical Trials (ID 6706)
11:20 - 11:40 | Author(s): E. Vallieres
- Abstract
- Presentation
Abstract not provided
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SC25.03 - Quality of Centers and Patient Inclusion (ID 6707)
11:40 - 12:00 | Author(s): J.G. Edwards
- Abstract
- Presentation
Abstract not provided
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SC25.04 - The Importance of Cooperation: The Essen Experience (ID 6708)
12:00 - 12:20 | Author(s): W. Eberhardt
- Abstract
- Presentation
Abstract not provided
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SC25.05 - Multimodality Trials: The Chinese Experience (ID 6898)
12:20 - 12:30 | Author(s): K. Chen
- Abstract
- Presentation
Abstract not provided
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Author of
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ED14 - Small Cell Lung Cancer (ID 283)
- Event: WCLC 2016
- Type: Education Session
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:J.B. Sørensen, S. Zöchbauer-Müller
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall C2
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ED14.04 - Is There a Role for Surgery in SCLC? (ID 6504)
15:15 - 15:30 | Author(s): G. Stamatis
- Abstract
- Presentation
Abstract:
The role of surgical treatment in the management of patients with small-cell lung cancer (SCLC) remains controversial. Although in the past, two randomized studies have failed to show any survival benefit by adding surgery to chemotherapy, different retrospective and prospective reports including the recently published studies using the database of Cancer Institute Surveillance Epidemiology and End Results (SEER), showed, that surgery offers a reasonable overall survival in a subset of patients with SCLC stage I and II disease. Two important recommendations have been introduced regarding the histology of SCLC as a high grade aggressive neuroendocrine tumor and the use of TNM classification in staging of SCLC and in clinical trials. Patient’s selection is important including extensive radiologic staging and biopsy of the mediastinal nodes. The use of PET scanning is likely to improve the accuracy of staging. Surgery can be performed with a curative intent in patients with SCLC and stage I or II disease or significant nodal response after chemotherapy. Weksler has used the SEER database and analyzed the outcomes of 3566 patients with SCLC stage I and II from 1988 to 2007. The surgical treatment was performed in 895 patients (25.1%); the median survival was 34 months in the surgical group versus 16 months in the nonsurgical group. In a similar report by Yu and colleagues, 21 the 5-year overall survival was 21.1%, but it was 50.3% for those patients who received a resection (45.7% after pneumonectomy and 33.7% after sublobar one). This analysis confirmed the acceptable survival rates in a subset of patients with stage I SCLC. By primary surgery or after induction chemotherapy complete tumor resection and systematic mediastinal lymphadenectomy should be undertaken. Adjuvant chemotherapy is recommended also for stage I patients; prophylactic cranial irradiation prolongs survival in those patients who achieve a complete or partial response to initial treatment. Until now, the standard systemic treatment of patients with LD-SCLC remains the combination of platinum and etoposide. The following groups of patients could potentially benefit from surgical resection: a. Patients with small lesion unexpectedly identified as SCLC at the time of thoracotomy. Complete resection and systematic lymph node dissection should be undertaken. Chemotherapy is recommended postoperatively and PCI should be considered. b. For stage I and II disease after chemotherapy and tumor response, surgery can improve local control and increase cure rates and long term survival. Complete resection and mediastinal lymph node resection should be performed. If possible, rather than pneumonectomy sleeve lobectomy should be preferred. c. In patients with mixed histology initial treatment should be chemotherapy to control the small cell component and after that surgery to control the non-small cell part of the tumor. d. For patients with initial failure to chemotherapy or patients with localized late relapse after treatment for pure small cell tumors salvage operations may be considered on individual basis. e. In patients with second primary small cell or non-small cell lung cancer who achieved cure from primary SCLC, surgery should be considered in the course of an multidisciplinary approach f. Patients with synchronous ispilateral or bilateral small and non small cell tumors could be potential candidates for surgery in a diagnostic or therapeutic intention g. In selected patients with IIIA N2 disease and complete histological regression of tumor tissue in the mediastinal lymph nodes after induction chemotherapy or chemoradiortherapy, surgery can improve local control and survival. Taking into account the TNM use in SCLC and the encouraging SEER results for patients submitted to surgery, a reconsideration of the role of surgery seems to be mandatory. Finally, to improve current management strategies for SCLC, surgeons should participate in the evaluation of SCLC patients together with oncologists and radiotherapists and common guidelines for indications and therapy concepts should be adopted. Interdisciplinary approaches should be employed in the context of controlled clinical trials. Fox W, Scadding JG. Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of the bronchus. Ten-year follow-up. Lancet 1973;2(7820):63-65 Lad T, Piantadosi S, Thomas P, et al. A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy. Chest 1994;106:320-323 Waddell TK, Shepherd FA. Should aggressive surgery ever be part of the management of small cell lung cancer? Thorac Surg Clin 2004;14:271-281 Eberhardt W, Stamatis G. Stuschke M, et al. Prognostically orientated multimodality treatment including surgery for selected patients of small-cell lung cancer patients stage Ib to IIIB: long-term results ofc a phase II trial. Br J Cancer 1999;81:1206-12 Shepherd FA, Crowley J, Van Houte P, Postmus PE, Carney D, Chansky K, Shaokh Z, Goldstraw P. International Association for the Study of Lung Cancer International Staging Committee and Participating Institutions. The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer. J Thorac Oncol 2007;2:1067-77 Valliéres E, Shepherd FA, Crowley J, Van Houte P, Postmus PE, Carney D, Chansky K, Shaokh Z, Goldstraw P. International Association for the Study of Lung Cancer International Staging Committee and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathological staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2009;4:1049-59 Yu JB, Decker RH, Detterbeck FC, et al. Surveillance Epidemiology and End Results Evaluation on the Role of Surgery for Stage I Small Cell Lung Cancer. J Thorac Oncol 2010; 5:215–9. Weksler B, Nason KS, Shende M, et al. Surgical resection should be considered for stage I and II small cell carcinoma of the lung. Ann Thorac Surg 2012; 94:889–93. Stamatis G. Neuroendocrine tumors of the lung: the role of surgery in small cell lung cancer Thorac Surg Clin. 2014 Aug; 24(3):313-26.
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