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Ann Thorac Surg 2006;82:1807
© 2006 The Society of Thoracic Surgeons
University of Modena and Reggio Emilia, Division of Thoracic Surgery, Largo del Pozzo 71, 41100 Modena, Italy
(Email: morandi.uliano{at}unimo.it).
Interest in the treatment of pulmonary large cell neuroendocrine carcinoma (LCNEC), a relatively uncommon tumor, has been growing among chest physicians in recent years. It is now accepted that this high-grade neuroendocrine tumor is associated with a poor prognosis after surgical resection, even in the early stages, with survival results significantly worse than stage-comparable conventional non-small cell lung carcinoma.
Some evidence supports the hypothesis of a similarity between LCNEC and small cell lung carcinoma (SCLC). These high-grade neuroendocrine neoplasms share similar morphologic aspects and molecular grounds, and genetic abnormalities have recently been confirmed with gene expression profiling analysis. These findings have led to the consideration of adjuvant chemotherapy with a SCLC-based regimen in all patients with resected LCNEC, but until now, only few cases in retrospective studies have been reported.
The article by Iyoda and collegues [1] prospectively evaluates the role of adjuvant chemotherapy in LCNEC. They used a regimen of cisplatin and VP-16, which is the current standard protocol for SCLC, and reported promising results in terms of chemotherapy toxicity and survival. The power of this study is limited, however, by the small number of patients analyzed (15 patients) and the short median 33-month follow-up of the adjuvant series that makes only a short-term outcome reliable.
The authors reported a surprising 2-year survival rate of 88%, which is significantly better than results previously reported in surgical series of LCNEC. Only a long-term outcome will clarify if these successful results are related to the multimodality therapy or are partially overestimated by the short follow-up period.
Another issue is the ideal schedule of chemotherapy administration. Most of the patients in the study received two courses of cisplatin and VP-16, and in 2 patients, only one course was administered. In current clinical practice, selected patients with early-stage SCLC that undergo surgical resection usually receive up to four cycles of adjuvant cisplatin and VP-16.
Before the adjuvant SCLC-based chemotherapy can be adopted as a standard of care in resected LCNEC, long-term confirmation of these preliminary results in a larger series is required. Given the relatively low incidence of this neoplasm, these end points will be obtained only with a prospective multicenter study. I congratulate Iyoda and colleagues [1], who have begun to take this path.
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