Abstract
BackgroundThe efficacy of combined modality therapy is evaluated for patients with extensive-stage (ES) small cell lung cancer (SCLC). This study evaluated prognostic factors affecting the risk of thoracic progression in ES-SCLC patients likely to undergo thoracic radiotherapy combined chemotherapy.MethodsA retrospective review of ES-SCLC patients who had received systemic chemotherapy at our hospital was performed. Tumor size, metastatic sites, and laboratory data at diagnosis were evaluated as potential prognostic factors. In ES-SCLC patients without pleural dissemination, the rate of thoracic progression after initial chemotherapy was assessed.ResultsEighty-three of 96 consecutive ES-SCLC patients were analyzed. The overall response rate was 55 %, median progression free survival was 5.0 months (mo), and overall survival (OS) was 9.2 mo. Tumor size (19.4 mo for ≤3 cm vs. 8.5 mo for >3 cm, p = 0.017) and the number of metastatic sites (12.9 mo for single sites vs. 7.1 mo for multiple sites, p = 0.015) were prognostic factors, in addition to known prognostic factors such as performance status and the levels of LDH and sodium. Cox proportional hazard model showed that the OS was significantly worse in patients with large (>3 cm) primary tumor size {HR 2.44 [95 % confidential interval (CI) 1.05–5.68], p = 0.038} and multiple metastatic sites [HR 1.81 (95 % CI 1.08–3.04), p = 0.026]. In 51 cases without pleural dissemination, the number of metastatic sites was associated with thoracic progression after initial chemotherapy (65 % for single sites vs. 36 % for multiple sites, p = 0.036).ConclusionLarge tumor size and multiple metastatic sites at diagnosis significantly predicted poor survival in ES-SCLC patients. Based on the high rate of thoracic progression in ES-SCLC patients with single site of distant metastasis, we should consider thoracic radiotherapy combined with chemotherapy for this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2222-4) contains supplementary material, which is available to authorized users.
Highlights
The efficacy of combined modality therapy is evaluated for patients with extensive-stage (ES) small cell lung cancer (SCLC)
This study suggested that ES-SCLC patients who respond to chemotherapy should be considered for thoracic radiotherapy (TRT) added to prophylactic cranial irradiation (PCI) with survival benefit; overall survival (OS) at 1 year, which was the primary endpoint in the study by Slotman, was not significantly improved (HR 0.84; 95 % confidential interval (CI): 0.69–1.01; p = 0.066) [15]
The present study suggested that large tumor size and multiple distant metastases were poor prognostic factors in ES-SCLC patients treated with chemotherapy
Summary
The efficacy of combined modality therapy is evaluated for patients with extensive-stage (ES) small cell lung cancer (SCLC). In a European study, PCI reduced the risk of brain metastases and prolonged the overall survival (OS) of ES-SCLC patients [13]. The use of TRT in addition to PCI following systemic chemotherapy was evaluated because intrathoracic progression was common in the European trial for ES-SCLC patients and 75 % of the patients had persisting intra-thoracic disease after chemotherapy. This study suggested that ES-SCLC patients who respond to chemotherapy should be considered for TRT added to PCI with survival benefit; OS at 1 year, which was the primary endpoint in the study by Slotman, was not significantly improved (HR 0.84; 95 % CI: 0.69–1.01; p = 0.066) [15].
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