Extended resection for higher‐stage non‐small‐cell lung cancer

作者：James D. Luketich, Dirk E. Van Raemdonck, Robert J. Ginsberg · 发表于：World Journal of Surgery · 年份：1993 · DOI：10.1007/bf01659081 · 被引用次数：16 · 研究领域：Lung Cancer Diagnosis and Treatment、Brain Metastases and Treatment、Lung Cancer Treatments and Mutations

This report reviews the results of extended surgical resection for advanced lung cancer (stage IIIa, IIIb, IV) reported in the Anglo-American literature between 1980 and 1993. Complete resection of stage IIIa (T3) tumors with minimal or no nodal involvement resulted in a 5-year survival approaching 40%. Ipsilateral mediastinal nodal involvement (N2) lowered 5-year survival to 10-15% and to near 0% if bulky disease was present. Historically, resection of stage IIIb disease has failed to improve survival. Radiation therapy has decreased local recurrence in advanced-stage disease but has not improved survival. Preliminary results have recently been reported using induction chemotherapy or chemoradiotherapy followed by resection in subsets of patients with stage IIIa and IIIb disease. Induction chemotherapy for bulky N2 (IIIa) disease resulted in major response rates of up to 77% and a 5-year survival of up to 26% after complete resection. Preliminary results of resection of stage IIIb tumors following induction chemotherapy have achieved 2-year survivals of 40%. Metastatic lung cancer (stage IV) with disseminated disease remains virtually incurable with poor response rates to chemotherapy. However, resection of isolated brain metastases (M1 disease) resulted in a 5-year survival near 25%. Resection of other sites of isolated metastatic disease including the adrenal gland is under investigation. The major prognostic factor in these studies has been the ability to completely resec...