İrfan TAŞTEPE, Yetkin AGAÇKIRAN, Erkmen GÜLHAN, Sadi KAYA, Pınar YARAN, Ertan AYDIN, Nurettin KARAOĞLANOĞLU, Ülkü YAZICI

Results of surgical resection in the treatment of small-cell lung cancer

Amaç: Çalışmada, cerrahi yaklaşımın küçük hücreli akciğer kanseri (KHAK) tedavisindeki önemi araştırıldı ve cerrahi yaklaşımla diğer tedavi yöntemlerinin bir araya getirilmesinin sağkalım üzerindeki muhtemel etkileri değerlendirildi. Çalışma planı: Ocak 1998 - Ocak 2008 tarihleri arasında klinik ve radyolojik olarak malignite şüphesi taşıyan, tanısal yöntemler etkin olmadığı için eksplorasyon amacı ile torakotomi uygulanan ve patoloji sonucu küçük hücreli akciğer kanseri olarak bildirilen 20 hasta (16 erkek, 4 kadın; ort. yaş 58.3 yıl; dağılım 41-76 yıl) retrospektif olarak incelendi. Olgulara radikal lenf nodu diseksiyonu ile beraber, 10 üst lobektomi, iki alt lobektomi, altı pnömonektomi ve iki inferiyor bilobektomi yapıldı. Tüm olgular yaş, cinsiyet, tanı yöntemleri, uygulanan ameliyatlar, ameliyat sonrası takip ve sağkalım sonuçları ile değerlendirildi. Bulgular: Ameliyat sonrası histopatolojik değerlendirme sonuçları küçük hücreli akciğer kanseri olarak bildirildi, 11 olguda miks tip tümör izlendi. Olgulardan beşi evre 1, altısı evre 2, dokuzu evre 3 idi. Ameliyat sonrası dönemde tüm olgulara kemoterapi ve nodal tutulumu olan olgulara radyoterapi uygulandı. Beş yılık sağkalım evre 1 ve 2 için %76, evre 3 için %13; N0 ve N1-2 olgular için ise sırasıyla %86 ve %15 olarak hesaplandı. Sonuç: Küçük hücreli akciğer kanseri de cerrahi tedavi erken evre (T1-2 N0) olgularda düşünülebilir. N2 varlığında cerrahi yaklaşımdan kaçınılması gerekmektedir. Cerrahi rezeksiyonun ardından ameliyat sonrası kemoterapi uygulanmalıdır ve nodal metastazlı olgularda mediastinal radyoterapi ilave edilmelidir.

Küçük hücreli akciğer kanseri tedavisinde cerrahi rezeksiyon sonuçları

Background: This study aims to investigate the role of a surgical approach in the treatment of small-cell lung cancer (SCLC), and evaluate the possible effects of combining the surgical approach with other treatment modalities for survival. Methods: Twenty patients (16 males, 4 females; mean age 58.3 years; range 41 to 76 years) who had a clinical and radiological suspicion of malignancy, who underwent an exploratory thoracotomy since diagnostic methods proved ineffective, and whose pathological results were reported as SCLC between January 1998 and January 2008 were reviewed retrospectively. Ten upper lobectomies, two lower lobectomies, six pneumonectomies and two inferior bilobectomies were performed along with radical lymph node dissection. All cases were evaluated according to age, gender, diagnostic methods, the operations performed, postoperative follow-up and survival results. Results: The results of the postoperative histopathological assessments were reported as small-cell lung cancer and mixed type tumors were observed in 11 cases. Five of the cases were stage 1, six were stage 2, and nine were stage 3. During the postoperative period all cases received chemotherapy, and radiotherapy was applied to the cases with nodal metastases. The five-year survival rate was calculated as 76% for stage 1 and 2 cases, 13% for stage 3 cases and 86% and 15% for N0 and N1-2 cases, respectively. Conclusion: Surgical treatment for SCLC can be considered in early stage (T1-2 N0) cases. In the presence of N2, a surgical approach should be avoided. Postoperative chemotherapy should be applied after surgical resection, and mediastinal radiotherapy should be added in cases with nodal metastasis.

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