Long-term survivors of small-cell lung cancer (SCLC): A French multicenter study

Abstract

Physical, mental and psychological states were considered as normal at 30 months in respectively 70.3%, 87.7% and 67.7% of patients, not influenced by prophylactic cranial irradiation, number of chemotherapy cycles, CCNU or cisplatin. Therapeutic sequelae were neurological impairment (13%), pulmonary fibrosis (18%) and cardiac disorders (11%) at 30 months. Return to work was possible for 40% of patients in the first two years following diagnosis. Among 43 relapsing patients, 33 benefited from a second-line treatment. Their median survival was 12 months since retreatment, and seven patients have survived again longer than 30 months. Age > 60 at the time of diagnosis was found as an independent factor increasing the risk of relapse beyond 30 months (OR = 2.46, IC 95% (1.16-5.26), P = 0.01). The risk of relapse became less than 10% beyond five years. Twenty patients (13%) developed a second primary cancer in a mean time of 58.6 months. The risk of second primary cancer was increased by a number of chemotherapy cycles > 6 (OR = 3.25, IC 95% (1.08-9.8) P = 0.02) and by an age > 60 (OR = 2.92, IC 95% (1.07-7.97), P = 0.03). Five- and 10-year survival rates were respectively 68% and 44%. In these patients having reached a 30-month survival, three independent factors were predictive of a survival longer than five years: age < or = 60 at the time of diagnosis (OR = 2.85, IC 95% (1.23-6.6), P = 0.01), chest radiotherapy (OR = 3.1, IC 95% (1.28-7.69), P = 0.006) and absence of relapse (OR = 4.5, IC 95% (1.75-12.5), P = 0.002). This study suggests that: 1) therapeutic sequelae are rather mild, allowing return to work in 40% of patients; 2) relapsing 30-month survivors can benefit from second-line treatment; 3) SCLC cure can be achieved with a 10-year follow-up.

Prognostic Factors in Non-small Cell Lung Cancer

“…The study also identified the following three prognostic subgroups for patients receiving cisplatin chemotherapy that had significantly distinct survival expectations: based on performance status, age, and hemoglobin and serum LDH levels. Other studies employing secondary analysis of clinical trial information have reached similar con- 54 Performance status 12,15,53,55-60 SVCO 1 Additional factors Anatomic Sex 12,52,56 "T" factor 10 Symptoms 27,60 "N" factor 10 Age 12 Clinical stage IIIA vs IIIB 61 Number of sites involved 12,53,62 Pleural effusion 63 Liver metastases 64 Clinical chemistry/hematology Hemoglobin 12,15,38,60 LDH 12 Albumin 57 New or promising factors Clinical chemistry/hematology Quality of life [16][17][18] Coagulation factors [65][66][67][68] Marital status 16 Proteinuria 69 Depressed mood 70 CYPIA1 37 Proliferation markers DNA ploidy and/or % S-phase 71 Ki-67 72 Other molecular biologic markers Replication errors 2p/3p 73 clusions, 13 as have retrospective studies of patients who were not enrolled in clinical trial protocols. 14,15 New and promising prognostic factors also are listed in Table 2.…”

Epidemiology of Lung Cancer Prognosis: Quantity and Quality of Life

“…Aging of the general population and advancements in early detection and treatment79, 80 will further increase the LTLC survivors in the population. Sometimes in the past, over a 30-month survival after a SCLC diagnosis was regarded as LTLC survivors 81. The majority of these LTLC survivors have undergone invasive treatment such as lung resection, radiation therapy, and/or chemotherapy; comorbidity burden in these survivors is especially high when compared to survivors of other cancer sites 82.…”

Development of second primary multiple myeloma five years after treatment for limited-stage small cell lung cancer: a rare case report

“…The cessation of cigarette smoking after successful therapy is associated with a significantly decreased risk of an SPM [7]. The risk of SPM was increased by a number of chemotherapy cycles > 6, an age of > 60, treatment with combination chemotherapy, and chest irradiation [8,9]. In a study including sixty-one patients who survived for more than two years, SPM was observed in seven patients (four with non-small cell lung cancer, two with gastric cancer, and one with prostate cancer) [10].…”