Abstract
BackgroundThere is controversy whether patients diagnosed with large-cell neuroendocrine carcinoma (LCNEC) should be treated according to protocols for non-small cell lung cancers (NSCLC) or small cell lung cancers (SCLC), especially with regard to the administration of prophylactic cranial irradiation (PCI). This study was set up to determine the incidence of brain metastases and to investigate the outcome following multimodal treatment in 70 patients with LCNEC.MethodsSeventy patients with histologically confirmed LCNEC were treated at the University Hospital of Heidelberg between 2001 and 2014. Data were collected retrospectively. Al most all patients received thoracic surgery as initial treatment (94 %). Chemotherapy was administered in 32 patients as part of the initial treatment. Fourteen patients were treated with adjuvant or definitive thoracic radiotherapy according to NSCLC protocols. Cranial radiotherapy due to brain metastases, mostly given as whole brain radiotherapy (WBRT), was received by fourteen patients. Statistical analysis was performed using the long-rank test and the Kaplan–Meier method.ResultsWithout PCI, the detected rate for brain metastases was 25 % after a median follow-up time of 23.4 months, which is comparable to NSCLC patients in general. Overall (OS), local (LPFS), brain metastases-free survival (BMFS) and extracranial distant progression-free survival (eDPFS) was 43, 50, 63 and 50 % at 5 years, respectively. Patients with incomplete resection showed a survival benefit from adjuvant radiotherapy. The administration of adjuvant chemotherapy improved the general worse prognosis in higher pathologic stages.ConclusionIn LCNEC patients, the administration of radiotherapy according to NSCLC guidelines appears reasonable and contributes to acceptable results of multimodal treatment regimes. The low incidence of spontaneous brain metastases questions a possible role of PCI.
Highlights
There is controversy whether patients diagnosed with large-cell neuroendocrine carcinoma (LCNEC) should be treated according to protocols for non-small cell lung cancers (NSCLC) or small cell lung cancers (SCLC), especially with regard to the administration of prophylactic cranial irradiation (PCI)
Survival was dependent on tumor stage: patients with stage I–II LCNEC showed 2- and 5-year overall survival rates of 67 and 48 %, while patients diagnosed with stage III–IV LCNEC had a 2- and 5-year overall survival of 39 and 29 %. 2- and 5-year progression-free survival rates (PFS) were 74 and 38 %, respectively (Fig. 1b)
In the present study, we evaluated incidence of brain metastases, treatment outcome and prognostic factors in 70 patients with LCNEC who received multimodal treatment
Summary
There is controversy whether patients diagnosed with large-cell neuroendocrine carcinoma (LCNEC) should be treated according to protocols for non-small cell lung cancers (NSCLC) or small cell lung cancers (SCLC), especially with regard to the administration of prophylactic cranial irradiation (PCI). The incidence of large-cell neuroendocrine carcinoma (LCNEC) is low as it accounts for about 3 % of all lung cancer cases [1, 2]. Rieber et al Eur J Med Res (2015) 20:64 for neuroendocrine markers [10, 11] Both LCNEC and SCLC are characterized by common clinical aspects including a predominance of males and smokers and aggressive clinical courses [11,12,13]. Analyzing 1,211 patients with LCNEC from the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute, Varlotto et al reported that the clinical, histopathological and biological characteristics of LCNEC were more similar to large-cell carcinoma than to SCLC [17]. The World Health Organization still categorizes LCNEC in the group of NSCLC
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