Comparing Treatment Strategies for Stage I Small-cell lung Cancer

Abstract

Stage I small-cell lung cancer is increasing in incidence and there are limited clinical data upon which to make treatment recommendations for this population. In this study we compared outcomes for patients receiving surgery, stereotactic body radiation therapy (SBRT), and conventional radiation therapy. Patients who underwent surgery had the best survival outcomes. For those who did not have surgery, SBRT resulted in better outcomes that standard radiotherapy. Introduction: The diagnosis of stage I small-cell lung cancer (SCLC) is increasing in incidence with the advent of low-dose screening computed tomography. Surgery is considered the standard of care but there are very few data to guide clinical decision-making. The purpose of this study was to compare outcomes for patients receiving definitive surgery, stereotactic body radiation therapy (SBRT), or external beam radiation therapy (EBRT) for stage I SCLC. Patients and Methods: Patients with a primary diagnosis of stage I SCLC were identified in the National Cancer Database. Patients were defined as having a first course of treatment of either surgery, EBRT, or SBRT. Overall survival (OS) was determined using the Kaplane—Meier method and Cox proportional hazards regression methods were used to estimate risk of overall mortality. Results: A total of 2678 patients were included in the analysis. The 2- and 3-year OS for the whole cohort was 62% and 50%. Comparing treatment strategies in a multivariate model, surgical resection showed improved OS over EBRT (P < .001) and SBRT (P < .001), however, the OS benefit over SBRT did not persist for patients who underwent limited resection. When excluding patients who underwent surgery, SBRT showed improved OS compared with EBRT (P ¼ .04). Additional use of chemotherapy with any treatment modality resulted in improved OS (P < .001). Conclusion: In this hospital-based registry study, definitive surgical resection and use of chemotherapy resulted in improved survival for patients with early stage SCLC. For patients who are not candidates for surgery, SBRT may offer a survival benefit compared with standard EBRT.

Surgery in patients with small cell lung cancer: A period propensity score matching analysis of the Seer database, 2010‑2015

“…On the other hand, the results also demonstrated that there were more patients between 60 and 90 years of age, who benefited from lobe/s, although this analysis was not performed in the subgroups ages <50 years, as no failure events were observed, and in the subgroups ages <40 years and between 90 and 100 years, due to the absence of observations. Another study comparing treatment strategies for stage I SCLC using the National Cancer Database (17) demonstrated that lobectomy was associated with an improved survival compared with limited resection (HR 0.64; 95% CI, 0.53–0.78; P<0.001). Schreiber et al (11) revealed that the median survival time for lobectomy and sublobectomy was 40 and 23 months, respectively (P<001).…”

Effect of histological subtype and treatment modalities on T1–2 N0–1 small cell lung cancer: A population‐based study

“…In the 1970s, two significant reports demonstrating poor survival in patients with SCLC after surgery compared to nonsurgical treatment made SCLC the exception for surgery . After some decades, several authors began to report the role of surgery as primary treatment in a small number of SCLC patients . In 2005, the Japan Clinical Oncology Lung Cancer Study Group reported three‐year survival of 68% for stage I disease after surgery and adjuvant chemotherapy …”

“…9,10 After some decades, several authors began to report the role of surgery as primary treatment in a small number of SCLC patients. [11][12][13] In 2005, the Japan Clinical Oncology Lung Cancer Study Group reported three-year survival of 68% for stage I disease after surgery and adjuvant chemotherapy. 14 The recently updated National Comprehensive Cancer Network (NCCN) guidelines recommend lobectomy and mediastinal lymph node sampling or dissection and adjuvant therapy according to pathologic N status.…”

Clinical Outcomes and Prognosis of Small-Cell Lung Cancer(SCLC) Patients After Surgery: a Single-Centre Retrospective Cohort Study from Peking Union Medical College Hospital

“…In the study of Liu et al [21], the rate of subpulmonary lobectomy in stage I patients reached 31%; neither this study nor previous studies found that subpulmonary lobectomy did not bring a survival bene t to stage I patients [22]. A portion of studies stated that lobectomy led to a more satisfactory prognosis than subpulmonary lobectomy [21,23,24], and the prognosis after lobectomy and subpulmonary lobectomy was superior to that after pneumonectomy [25]. In the present study, the patients underwent subpulmonary lobectomy, lobectomy, or compound lobectomy (including pneumonectomy), and the survival curve showed that the prognosis after subpulmonary lobectomy was worse (Fig.…”