Treatment outcomes in patients with extensive stage small cell lung cancer - Experience from a tertiary Indian cancer centre

Abstract

19129 Background: Small cell lung cancer (SCLC) is an aggressive malignancy associated with early metastasis and mortality. However, its exquisite sensitivity to chemotherapy and radiotherapy allows for durable clinical responses being achieved even in advancedstage. Multimodality approach through combination chemotherapy and radiotherapy remains the cornerstone for its treatment. Methods: Records of patients with extensive stage SCLC treated at our institution from 2003 to 2006 were analyzed. Their responses and time to disease progression were analyzed retrospectively. Results: A total of 26 patients with extensive stage SCLC were available for analysis. All patients were males with age between 44 and 73 years (Median-60 years). Twenty three patients (82.1%) were smokers. Eighteen patients (64.2 %) had distant metastasis at diagnosis with the adrenal gland being the commonest site (39%). Two patients presented with symptoms of superior venacaval obstruction. Twenty six patients (92.8%) received 6 cycles of palliative chemotherapy with 19 (67.8%) receiving Irinotecan -Cisplatin and 7 (25%) receiving Etoposide-Cisplatin combination. Of the 26 patients treated, complete response (CR), partial response (PR) and progressive disease (PD) were seen in 23% (n=6), 30.7% (n=8) and 23% (n=6) respectively, giving an overall response rate (ORR) of 53.8%. Nine patients (34.6%) in either CR or good PR were given prophylactic cranial irradiation (PCI). At a median follow up of 6 months (Range 10 days -25.5 months), 7.1% (n=2) patients remained disease free. The median relapse free survival was 6.44 months (CI- 5.6–7.3 months). Disease progression after an initial response was seen in 65.3% patients (n=12). Two patients died due to chemotherapy related toxicity and six patients were lost to follow up. Conclusions: Chemotherapy can induce good overall responses in extensive stage SCLC. The initial responses are excellent with short time to progression which is highlighted in our series too. The CR rates are comparable to most published series and PCI may offer an advantage in a those patients who do achieve an excellent partial or complete response. No significant financial relationships to disclose.