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Surgery for Advanced Lung Cancer Questioned

Wed October 22, 2003 02:23 PM ET

By Megan Rauscher

NEW YORK (Reuters Health) - Does surgery improve survival of people with advanced lung cancer compared with that achieved with chemo and radiation alone? The results of a large trial show no definite advantage with either strategy.

Dr. Andrew T. Turrisi from Wayne State University in Detroit presented the findings at the annual meeting of the American Society for Therapeutic Radiology and Oncology in Salt Lake City.

In an interview with Reuters Health, Turrisi noted that the best treatment has yet to be defined for patients with late-stage lung cancer that has spread to the lymph nodes. "Two influential but small reports--one from Europe and one from Texas--suggested that chemotherapy followed by surgery was better than surgery alone," he explained.

"Another very large randomized trial showed that if induction chemoradiotherapy (i.e., chemotherapy plus radiation therapy) followed by resection led to clearance of disease from the lymph nodes, but not necessarily the primary tumor, that identified a group of patients who were going to survive remarkably well," he added.

Turrisi's team tried to isolate the benefit of surgery by randomly assigning 392 late-stage lung cancer patients to a chemoradiotherapy-only arm or to a group given chemoradiotherapy followed by surgery.

"Our statistical goal was a 10-percent benefit in the surgical arm. Also, we expected that the non-surgical arm would survive at a level of only 25 percent at 2 years. Neither proved true," Turrisi said.

"A very important fact is that the 2-year survival for the chemoradiotherapy arm without surgery was 15 percentage points higher than we expected," he continued. Since the nonsurgical therapy group did much better than expected, and the surgical group fared no worse than anticipated, the outcomes were similar.

"With current follow-up, there is no difference in survival between the two treatment arms that is worth talking about," Turrisi said. Specifically, at 3 years, the survival rate was over 30 percent in both arms.

An analysis of the data showed that surgery did slow the progression of cancer, but on the other hand it was linked to significantly more deaths related to surgery itself and to non-cancer causes.

As Turrisi pointed out, "Any benefit that you might derive from better cancer control was balanced by some loss from surgical mortality, which was about 6 to 7 percent, and non-cancer deaths, which was about 10 percent."

So how would he advise a patient faced with a diagnosis of advanced lung cancer?

"When presenting this to a patient," he replied, "one would have to say that surgery might be better in the long run, but in the short run you might have excess mortality, treatment-related toxicity and deaths from the procedure."

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