Prognostic Factors and Treatment of Earlystage Small-cell Lung Cancer

Abstract

Abstract. Background Small-cell lung cancer (SCLC) classified as early stage at the point of diagnosis is very rare representing only 5% of all SCLC patients (1). The low incidence of early stage SCLC is mainly attributable to highly aggressive biology, rapid tumour growth, the absence of early symptoms and a lack of established screening programs (2, 3).Radiochemotherapy remains the standard treatment in limited stage SCLC resulting in a median overall survival of 16-20 months (2-4). Several biomarkers such as survivin and alternatively spliced actinin-4 variant expression have been identified recently to impact the prognosis of patients with SCLC (5, 6). The optimal treatment of early stage SCLC and subgroups of these patients remain an issue of debate. An increasing number of patients with early stage SCLC receive surgical treatment resulting in a favourable median overall survival of 29-91 months (1, 7-9). However, randomised controlled trials comparing different treatment modalities in early stage SCLC are still warranted. Additionally, potential prognostic factors in these patients still remain unclear. This study aimed to identify prognostic factors in patients undergoing standard radiochemotherapy for early stage SCLC. Patients and MethodsEight SCLC patients diagnosed stage I or II according to the "Union internationale contre le cancer" (UICC) staging were treated with radiochemotherapy of the primary tumour and involved lymph nodes between 2006 and 2009. Median age was 64 years. Chemotherapy consisted of two to six courses of etoposide (120 mg/m 2 on days 1-3) plus cisplatin (60-80 mg/m 2 on day 1) or carboplatin (AUC 6 on day 1).The radiation dose was given as equivalent dose in 2 Gy fractions (EQD2). Two EQD2 levels (≤59 vs. >59 Gy, median radiation dose was 59 Gy) and seven factors were evaluated for potential associations with overall survival. These factors were gender, age (<64 vs. ≥64 years, median age=64 years), Karnofsky performance score (≤70 vs. >70), N-category (0 vs. 1), UICC-stage (I vs. II), simultaneous chemotherapy (yes vs. no) and prophylactic cranial irradiation (yes vs. no).Follow-up visits were conducted every year up to four years, and follow-up time was referred to the end of radiotherapy treatment. Univariate analysis was performed using Kaplan-Meier method and log-rank test (10). The characteristics that showed a significant association with survival (p<0.05) were included in a multivariate (Cox regression) analysis. ResultsMedian overall survival was 46 months after the end of radiotherapy. Detailed survival data are summarized in Table I DiscussionEarly stage small-cell lung cancer at the point of diagnosis is rare, and optimal treatment for early stage SCLC is controversial. Radiochemotherapy remains the standard treatment for limited staged disease (2), but operative treatment plays an emerging role (1, 7-9). The American College of Chest Physicians (ACCP) recommend a surgical resection followed by platinum-based adjuvant chemotherapy for selected patients with stage I SC...

Clinical Outcomes of Stereotactic Body Radiotherapy for Patients With Stage I Small-Cell Lung Cancer: Analysis of a Subset of the Japanese Radiological Society Multi-Institutional SBRT Study Group Database

“… 28 , 29 A small retrospective study indicated that PCI was a significant predictor of survival in patients with stage I to II SCLC treated with chemoradiotherapy. 30 However, it has not been established whether PCI is essential, especially for stage I patients. In our series, distant metastases were a major pattern of recurrence, and the brain was one of the frequent sites of distant metastases (as was the liver).…”

Factors associated with overall survival, progression-free survival and toxicity in patients with small cell lung cancer and thoracic irradiation in a clinical real-world setting

“…Previous publications have already identi ed further prognostic factors associated with prolonged OS, like female sex 29303132 , KPS ≥ 70 33 respectively Eastern Cooperative Oncology Group (ECOG) performance status 0-1 3432 or N-Stage 0-2 33 as well as therapy-related factors like radiation dose > 52 Gy 33 or PCI. 35 In our analysis, trend of protective in uence of female sex, KPS 80-100 in OS were detected but insigni cant.…”

Factors associated with overall survival, progression-free survival and toxicity in patients with small cell lung cancer and thoracic irradiation in a clinical real-world setting

“…But it must be noted that due to the wide confidence interval in these results, a negative effect on OS and PFS cannot be ruled out. Previous publications have already identified further prognostic factors associated with prolonged OS, like female sex [ 30 – 33 ], KPS ≥ 70 [ 34 ] respectively Eastern Cooperative Oncology Group (ECOG) performance status 0–1 [ 33 , 35 ] or N-Stage 0–2 [ 34 ] as well as therapy-related factors like radiation dose > 52 Gy [ 34 ] or PCI [ 36 ]. In our analysis, a trend of protective influence of female sex, KPS 80–100 in OS were detected but insignificant.…”