Eur J Cardiothorac Surg 2005;27:732
© 2005 Elsevier Science NL
Reply to Pramesh et al.
Hidehito Matsuoka*
The Department of Surgery, Hyogo Prefectural Kaibara Hospital, 5208-1, Kaibara, Kaibara-cho, Tanba city, Hyogo 669-3395, Japan
Received 6 January 2005;
accepted 10 January 2005.
* Tel.: +81 795 0524; fax: +81 795 1276. (E-mail: hmatsuoka1{at}mac.com).
Key Words: Lung cancer • Survival • Chest wall invasion • Operation
My coauthors and I thank Dr Pramesh's suggestions on our report [1]. I recognize the value of the comments about neoadjuvant therapy or postoperative chemotherapy. A role of cisplatin-based adjuvant chemotherapy or single-agent therapy with uracil-tegafur in patients with resected stage I or stage II non-small cell lung cancer has come under review in recent years [2,3]. And some randomized trials have shown significantly improved survival with induction chemotherapy [4,5]. But most clinical studies have failed to improve the prognosis of patients with advanced disease such as multiple N2 or N3 status. These are sill controversial. In our 21 incompletely resected cases, 8 had gross residual metastatic lymph nodes, 3 had microscopic positive margins of the tumors and 10 had positive pleural lavage cytology. There was no significant difference in survival among these groups. We have had no postoperative radiotherapy in a prescribed fashion for residual tumors, but most patients actually received some radiation. Distant metastasis had a majority in the patterns of recurrence in patients with incompletely resected disease. So we believe that control of distant metastasis is most important in even such cases.
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