Small cell carcinoma of the lung. A progress report of 15 years' experience

Abstract

To assess the results of therapeutic advances in the treatment of small cell carcinoma of the lung (SCCL) achieved during the past 15-year period at a single large institution, 508 patients treated between 1968 and 1982 were divided into two groups: 157 patients (66 in the category of limited-stage disease and 91 in the extensive-stage disease category) treated with low-dose small-volume radiotherapy (RT) (time dose fractionation [TDF] 49-66) and with cyclophosphamide alone or a COPP program during the first period of 7 years (1968-1974); 351 patients (180 in limited and 171 in extensive stage) treated with multidrug chemotherapy (CT) and high-dose large-volume RT (TDF 73-89) during the second period of 8 years (1975-1982). For patients with limited-stage cancer, 5-year actuarial survivals were 3% versus 7% for the periods 1968-1974 versus 1975-1982, respectively, P less than 0.01. For patients with extensive-stage cancer, the median survival time (MST) and 2-year actuarial survivals were 5 months and 2% versus 7 months and 4% for the periods 1968-1974 versus 1975-1982, respectively. To evaluate the outcome of a contemporary approach, i.e., CT alone, with RT reserved for locoregional failure, 180 patients with limited-stage cancer who were treated (1975-1982) were further analyzed for MST, 2- and 5-year actuarial survival figures, and local-tumor control rates according to the therapeutic approaches employed: CT + RT (112); CT alone (36); RT alone (17); and surgery (S) +/- CT +/- RT (15). Although the 36 patients in CT alone seems a small number, 17 of the 36 patients were enrolled in this approach in 1981-1982, reflecting a shift of emphasis from RT to CT. The MST and 2-year actuarial survival figures were 11 months and 0% versus 13 months and 21% for CT alone versus CT + RT respectively, P less than 0.05. CT + RT achieved a 5-year cure rate of 8%. S +/- CT +/- RT or RT alone also achieved 5-year cure rates of 8% and 10.5%, respectively, in selected subsets of patients. Local relapse rates were 80% (29/36) versus 25% (28/112) for CT alone versus CT + RT. These data emphasize the importance of thoracic RT given at the early phase of treatment to improve long-term survival for patients with limited-stage SCCL.

Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe

“…Its features are: rapid progression, short doubling time, high growth fraction, and sensitivity to multiple chemotherapeutic agents and radiation therapy. Short-term survival seems to have improved since the introduction of chemotherapy in the 1970s [107,108,112]. In Mersey and Yorkshire, England, UK, the population-based 2-year survival rate improved from 2% in the 1970s to 8% in the 1980s and in the southeastern part of The Netherlands the population-based relative 1-year survival rate improved from 15% in the 1970s to 35% in the 1980s, but there was no further improvement in the 1990s and 2-year survival did not exceed 8% [106,113].…”

“…Furthermore, results of chemotherapy have reached a plateau and further improvement seems impossible with the currently available tools [106 -108,152]. The response rates and survival rates after combination chemotherapy with irradiation were moderately higher than after combination chemotherapy alone [112,[153][154][155][156].…”

Modest Improvements of Survival for Patients with Small Cell Lung Cancer Aged 45 to 59 Years Only, Diagnosed in the Netherlands, 1989 to 2008

“…Previous studies have shown some progress in survival since the introduction of chemotherapy: 1-year relative survival rates improved from 18% in the 1970s to more than 30% in the 1990s for patients up to 70 years and from 9% to almost 20% for the elderly. 4,7,[43][44][45] We have shown that survival for the group of patients with SCLC as a whole has not further improved since the early 1990s, except for age group 45 to 59 years since the mid-2000s. However, when stratifying according to stage, 1-year relative survival for both patients with LD and ED has improved, as was also found in an American study.…”

Phase II Trial of Oral Topotecan and Intravenous Carboplatin With G-CSF Support in Previously Untreated Patients With Extensive Stage Small Cell Lung Cancer

“…1–4 Despite a favorable initial response to chemotherapy, the prognosis for these patients remains poor, with a median survival time of 8 to 9 months. Treatment results in the 1990s have plateaued with no major advances in therapy as compared with the 1970s.…”