The study included 7 men and 4 women, with a median age of 62 years (range, 35 - 72). According to the Masaoka staging system, 3 patients had stage II disease, 1 stage III disease, 3 stage IVa disease and 4 stage IVb disease. Pathologically, 10 patients had squamous cell carcinoma, whereas 1 had large cell neuroendocrine carcinoma (LCNEC). We performed surgery or multimodality therapy including surgery as the initial therapy for 8 patients. Of the non-surgical cases, 1 patient received chemoradiotherapy, whereas 2 received palliative care.

Table 1 summarizes all cases with respect to their initial treatment and respective outcomes. One patient (case 7) from the non-surgery group received pericardial drainage and died 21 months after the diagnosis. A second patient (case 8) was treated with radiotherapy to the site of bone metastasis followed by chemotherapy and eventually died 23 months later. Another patient (case 9) received chemotherapy consisting of cisplatin and docetaxel with concurrent thoracic irradiation in accordance with the OLCSG 0007 protocol [6]; this patient is still alive 6 years later without disease progression (Figure 1).

In the surgical intervention group, 1 patient received surgery alone, 2 patients received surgery and adjuvant radiotherapy, 3 patients received surgery with adjuvant chemotherapy and subsequent radiotherapy, and 2 patients received preoperative chemoradiotherapy, surgery, and adjuvant chemotherapy. Complete resection was performed in 4 of the 8 cases (Table 2). In the complete resection group, 3 of 4 patients were alive and disease free at the time of reporting, whereas the other patient (case 2) had recurrence of pleural dissemination. In the incomplete resection group, 1 patient with LCNEC was alive with no evidence of disease following postoperative radiotherapy and chemotherapy consisting of carboplatin and etoposide at the time of reporting.

However, the other 3 patients experienced disease recurrence. As shown in Table 2, better outcomes were achieved in patients at an early Masaoka stage and in those who underwent complete resection together with radiotherapy and chemotherapy.

Table 3 shows the site of disease recurrence in each patient who received surgery. Manifestations of disease recurrence were dissemination to the pleura, supraclavicular lymph nodes, and lungs. Seven of the 11 patients are still alive. The median survival time and 5-year survival rate were 63.7 months and 58.3%, respectively.