Adjuvant Chemotherapy Extends OS in Early-Stage NSCLC


“Adjuvant chemotherapy following complete surgical resection improved OS among patients with early-stage non–small cell lung cancer, according to a study published in Journal of Thoracic Oncology.

“Patients diagnosed with medically operable, early-stage non–small cell lung cancer typically undergo complete resection.

“However, 5-year OS is ‘suboptimal, ranging from 73% in patients with pathologic stage IA to 24% in those with stage IIIA,’ Daniel Morgensztern, MD, associate professor at Washington University School of Medicine in St. Louis and member of the International Association for the Study of Lung Cancer, and colleagues wrote.”

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Benefits of Surgical Resection for Small Cell Lung Cancer Remain Unclear

“Although surgical resection resulted in reasonable outcomes among well-chosen patients with early-stage small cell lung cancer, use of the treatment approach in this setting remains controversial, according to study results.

“Intrathoracic recurrence — the most common treatment failure in the study — occurred more frequently in patients who underwent limited resections. Thus, the researchers determined additional research is needed to assess the overall efficacy of combining surgery with chemotherapy and radiation therapy.

“ ‘Small cell lung cancer (SCLC) accounts for approximately 15% of the primary lung cancer diagnoses in the United States each year,’ Yolanda I. Garces, MD, of the department of radiation oncology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. ‘The current National Comprehensive Cancer Network guidelines recommend surgical resection as the preferred first-line treatment for patients with early-stage, node-negative disease. The purpose of this study was to evaluate clinical outcomes and patterns of recurrence in a single-institution series of patients undergoing curative resection of SCLC.’ ”

Surgery for Stage I SCLC Provides Survival Benefit

The gist: A recent study found that people with stage I small cell lung cancer (SCLC) might survive longer if they have surgery to remove part of the lung affected by cancer. The study compared survival rates between patients who had surgery and patients who had other forms of treatment. Five years after treatment, 62% of the patients who had surgery were still alive, compared to 25% of the patients who did not have surgery.

“Patients with stage I limited-disease small cell lung cancer who underwent surgical resection demonstrated a significant survival advantage compared with those who received nonsurgical treatment, according to results of a retrospective study.

“Surgical resection also appeared effective in some patients with stage II or stage II limited-disease small cell lung cancer (LD-SCLC), results showed.

“ ‘Although chemotherapy and radiotherapy are recommended for patients with LD-SCLC, several series have reported favorable survival outcomes even in patients with stage II and stage III disease who underwent surgical resection,’ Tomoyoshi Takenaka, MD,of the department of thoracic oncology at National Kyushu Cancer Center in Fukuoka, Japan, and colleagues wrote.

“In the current study, Takenaka and colleagues analyzed the outcomes of 277 patients aged 38 to 89 years (median, 66 years; 81% men) treated for LD-SCLC from 1974 to 2011 at National Kyushu Cancer Center…

“ ‘Surgical resection provided a survival benefit for the patients with clinical stage I SCLC and some cases of stage II or stage III disease in this study,’ Takenaka and colleagues wrote. ‘The outcomes of treatment for SCLC have been improved beginning in the 2000s. A further prospective study is warranted to clarity the possibility of extending the indications for surgical resection to curatively treat LD-SCLC in the present situation.’ ”

Adjuvant Radiation Therapy Improved Survival in Diffuse-Type Gastric Cancer

Editor’s note: Researchers conducted a clinical trial with volunteer patients to test whether giving radiation after tumor-removal surgery could stave off recurrence for people with diffuse-type gastric cancer. A treatment that follows an initial treatment to reduce the risk of the cancer returning is known as an “adjuvant therapy.” In this clinical trial, patients who received adjuvant radiation therapy after surgery survived significantly longer than patients who did not.

“Patients with diffuse-type gastric cancer demonstrated prolonged OS when they received adjuvant radiation therapy, according to results of a SEER analysis.

“Alexander M. Stessin, MD, PhD, of the department of radiation oncology at Weill Cornell Medical College, and colleagues used the 2002 to 2005 SEER database to identify 1,889 patients with newly diagnosed diffuse-type gastric cancer who underwent surgical resection. Of these patients, 782 received adjuvant radiation therapy and 1,107 did not.

“Patients who received adjuvant radiation therapy were younger, more likely to have ≥15 dissected lymph nodes and more likely to have N3 lymph node status. They also had a higher American Joint Committee on Cancer disease stage.”