Treatment Results of Chemotherapy and Radiotherapy in Limited-Stage Small Cell Lung Cancer

Abstract

Purpose: The purpose of our study was to evaluate the treatment results and to analyze the prognostic factors affecting the outcome of limited-stage small cell lung cancer patients treated with combined chemotherapy and radiotherapy. Materials and Methods: From January 1997 through September 2003, there were 27 patients diagnosed as limited-stage small cell lung cancer in Changhua Christian Hospital, Taiwan. Among the 27 patients treated with chemotherapy and radiotherapy, 22 (82%) were male and 5 (18%) were female. The median age of diagnosis was 61 years. According to the ECOG (Eastern Cooperative Oncology Group) performance status scaling system, 3 patients (11%) were ECOG 0, 20 patients (74%) were ECOG 1, and 4 patients (15%) were ECOG 2. The treatments consisted of either concurrent chemoradiotherapy (CCRT) or chemotherapy followed by radiotherapy. Chemotherapy regimens were cisplatin and etoposide. The median thoracic irradiation dose was 55.8 Gy (range: 45-64.8 Gy). Results: There were 15 patients (55%) achieving complete response, and 4 patients (15%) having partial response, with a total local response rate of 70%. Only one patient (7%) had local relapse out of 15 patients with complete tumor response. A total of 14 patients achieved local regional control (52%, 14 out of total 27 patients). Thirteen patients (48%) had distant metastasis, and 9 patients (69%) died of their diseases during the follow-up periods. The mean survival time was 28 months. In survival analysis, the 1- year, 2-year and 5-year overall survival rates were 67%, 54% and 43%, respectively. The 1-year, 2-year and 5-year disease-free survival rates were 68%, 36% and 22%, respectively. The 1-year, 2-year and 5-year disease-specific survival rates were 67%, 58% and 46%, respectively. In prognostic factors analysis, cumulative irradiation dose (p=0.018) was a predictor for local response. Body weight loss (p=0.010), cycles of chemotherapy (p=0.007) and local response (p=0.032) were prognostic factors for overall survival. Body weight loss (p=0.037), cycles of chemotherapy (p=0.001) and distant metastasis (p=0.001) were prognostic factors for disease-free survival. Body weight loss (p=0.004), cycles of chemotherapy (p=0.030) and local response (p=0.050) were prognostic factors for disease-specific survival. Conclusion: Chemotherapy of cisplatin and etoposide combined with radiotherapy is a feasible treatment modality for patients of limited-stage small cell lung cancer. A local response rate of 70%, and a 2-year overall survival of 54% were achieved. However, distant failure is still the major concern affecting survival in our present study. Among the 15 patients died of their diseases, 9 patients (60%) were dead due to distant metastasis. The modifications of chemotherapy regimens and radiotherapy techniques in further clinical trials are warranted to explore an optimal treatment and to achieve a satisfactory out- come for limited-stage small cell lung cancer.