Timing of failure in limited disease (stage I-III) small-cell lung cancer patients treated with chemoradiotherapy: a retrospective analysis.

Abstract

Follow-up in limited disease (stage I-III) small cell lung cancer could be further optimized by assessment of the temporal and locational distribution of treatment failure after completion of chemoradiotherapy. Follow-up was retrospectively analyzed in 125 limited disease (stage I-III) small cell lung cancer patients with initial performance status WHO <3 who had successfully completed chemoradiotherapy. Thoracic irradiation was applied in the concurrent or sequential mode. Time from initial pathological diagnosis and treatment end to local, distant and brain recurrence was documented. One- and two-year progression-free survival rates were 50% and 27.2% in patients treated with concurrent and 45.2% and 14.2% in those treated with sequential chemoradiotherapy, respectively. Local relapse was documented in 14% patients treated with concurrent and 16% with sequential chemoradiotherapy. The distant failure rate was 43% in both subgroups. Up to the end of the follow-up period, more patients treated with concurrent chemoradiotherapy had developed brain metastases than those treated sequentially (37% vs 20%, P = 0.049). Median time (in days) to local relapse was 376 and 401 from the initial diagnosis, 200 and 309 from the end of chemotherapy, and 316 and 196 from the end of thoracic irradiation; to distant failure was 275 and 298 from the initial diagnosis, 151 and 157 from the end of chemotherapy and 180 and 84 from the end of thoracic irradiation; to brain relapse was 330 and 273 from the initial diagnosis, 123 and 151 from the end of chemotherapy and 213 and 73 from the end of thoracic irradiation in patients treated with concurrent and sequential chemoradiotherapy, respectively. There was no significant difference in the temporal distribution of treatment failure in either subgroup. In more than half of the patients who developed a distant recurrence, including brain metastases, treatment failure occurred in the first year after the initial diagnosis. Intensified follow-up can be recommended at least in the first year, because no sufficient eradication of the systemic small cell lung cancer with the applied chemoradiotherapy protocol could be achieved.