Evidence from clinical trials neither supports nor refutes a benefit for surgery as a treatment for the most common type of lung cancer, non-small cell lung cancer or NSCLC, according to findings from the first-ever systematic review to address this topic.

The review, which appears in the medical journal Thorax, involved 11 trials that included data on patients who underwent surgery for NSCLC.

Six of the studies, which included more than 1000 patients, focused on surgery vs. no surgery, while the remaining five, which included over 1100 patients, compared various surgical approaches.

As noted, the results generally showed no survival advantage or disadvantage for surgery compared with non-surgical therapy, Dr. R. L. Manser, from St. Vincent’s Hospital Melbourne in Victoria, Australia, and colleagues report.

In one small study, however, chemotherapy followed by surgery rather than by radiation treatment did seem to improve survival of patients with more advanced disease.

In terms of the surgical approach, more extensive tissue removal was often linked to better outcomes. For example, in a pooled analysis of three studies, the survival rate at four years was improved with a complete removal of lymph nodes. In another study, removal of an entire lobe of the lung appeared to reduce recurrence of early-stage disease compared with limited resection.

“It is difficult to draw conclusions” about the efficacy of surgery for NSCLC, the authors state. The results of ongoing trials may help clarify this issue, they add.

SOURCE: Thorax, July 2006.