Abstract
Introduction: Treatment algorithms for small cell lung cancer (SCLC) are determined largely by the Veterans Affairs Lung Cancer Staging Group (VALCSG) staging (limited (LS) versus extensive (ES) stage). Relapse occurs frequently; however, patterns of relapse, in particular the competing risk of thoracic and central nervous system relapse, are not well described. This study describes patterns of relapse in SCLC patients treated at a large tertiary institution in Ontario, Canada. Materials and Methods: A retrospective cohort of SCLC patients treated at the Juravinski Cancer Centre was reviewed. Data were abstracted from the medical record on demographic, disease, treatment and outcome variables. The primary outcome was a description of the patterns of relapse stratified by disease stage. Multivariate analysis was performed to identify prognostic variables for thoracic and CNS relapse. Results: Two hundred and twenty nine patients were treated during the study period (LS—83, ES—146). Relapse occurred in the majority of patients (isolated thoracic—28%, isolated CNS—9%, extrathoracic—9%, thoracic/extrathoracic—14%, systemic and CNS—13%). The median OS was consistent with published data (LS—21.8 months, ES—8.9 months). ES disease and elevated LDH were prognostic for increased thoracic relapse, whereas poor PS and older age were prognostic for lower central nervous system (CNS) relapse. Discussion: Thoracic relapse and CNS relapse represent competing risks for patients with SCLC. Decisions about incorporating thoracic or CNS radiation are complex. More research is needed to incorporate performance status and LDH into treatment algorithms.
Highlights
Treatment algorithms for small cell lung cancer (SCLC) are determined largely by the Veterans Affairs Lung Cancer Staging Group (VALCSG) staging (limited (LS) versus extensive (ES) stage)
A treatment-based staging system developed by the Veterans Affairs Lung Cancer Study Group (VALCSG) was used in SCLC [4], with disease confined to one hemithorax that could be encompassed in a single radiation field classified as limited stage (LS) disease, and everything else was classified as extensive stage (ES) disease
Patients with SCLC are at high risk for the development of brain metastases, and a meta-analysis of randomized trials supports the use of prophylactic cranial irradiation (PCI) in LS SCLC patients achieving a complete response to their initial chemoradiation therapy [7]
Summary
Treatment algorithms for small cell lung cancer (SCLC) are determined largely by the Veterans Affairs Lung Cancer Staging Group (VALCSG) staging (limited (LS) versus extensive (ES) stage). This study describes patterns of relapse in SCLC patients treated at a large tertiary institution in Ontario, Canada. Discussion: Thoracic relapse and CNS relapse represent competing risks for patients with SCLC. A treatment-based staging system developed by the Veterans Affairs Lung Cancer Study Group (VALCSG) was used in SCLC [4], with disease confined to one hemithorax that could be encompassed in a single radiation field classified as limited stage (LS) disease, and everything else was classified as extensive stage (ES) disease. The primary treatment of SCLC is platinum-based chemotherapy, with thoracic radiation routinely added to the management of patients with LS SCLC [6]. The gains in OS from these treatments are modest at best and the selection of patients most likely to benefit remains challenging
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