Treatment of small cell lung cancer

The treatment of small cell lung cancer (SCLC) has been the subject of several reviews,

ranging from guidelines developed by the American College of Chest Physicians to a full

supplement on the treatment of SCLC, and in addition the progress in the treatment of

SCLC during the last three decades has been highlighted in a historical overview.

With regard to the overall management of SCLC, in Lung Cancer Therapy Annual 3,

we described, on the basis of an abstract presentation, the results of a study from North

America analyzing survival trends in patients with limited-stage SCLC from randomized

clinical trials performed by cooperative groups in North America, initiated between 1972

and 1982 and completed by 1996. These data have now been published in full,

demonstrating meaningful improvements in survival, with doubling of the 5-year survival

rate of patients with limited-stage SCLC listed in the US Surveillance, Epidemiology, and

End Results Program (SEER) database.

Similar results have been obtained from a French region in a study analyzing data in

the period 1981–83 including 787 patients. The median survival time increased for the

overall population from 6.6 months in 1981–83 to 11.3 months in 1993–94 (p=10−5), for

patients with limited disease from 9.2 months to 14.0 months (p=0.002), and for those

with extensive disease from 3.5 months to 9.6 months (p=10−5).

Long-term treatment results are also available from the Saskatchewan Cancer Centre

in Canada. Between 1981 and 1998, 1447 new cases of SCLC were diagnosed, 244 of

which were limited-stage and were treated with curative intent. They were followed to

the end of February 2002. A parametric log-normal statistical model was retrospectively

validated to determine whether long-term survival rates could be estimated several years

earlier than is possible using the standard life-table actuarial method. The results showed

that the survival time of the uncured group followed a log-normal distribution. The

estimated 10-year cause-specific survival rate was 13% according to the log-normal

model, while a Kaplan-Meier calculation gave 15% ± 3%. The data also showed that

absence of mediastinal lymphadenopathy and higher chest radiotherapy dose were

significant prognostic factors on multivariate analysis (p<0.05). Among the 163 patients

given prophylactic cranial irradiation (PCI), a higher biologically effective dose to the

brain did not improve survival or decrease the incidence of brain metastases.

In Japan, a pattern-of-care study (PCS) was conducted as a nationwide survey of

radiotherapy for patients with SCLC between September 1988 and March 2001. It was

shown that age stratification had no impact on the variables of radiotherapy such as total

dose and field size. Overall, only 37% of patients received chemotherapy and thoracic

radiotherapy concurrently, with the proportion of patients being 44%, 27%, and 25% of

the younger, intermediate, and elderly groups, respectively. The overall survival rate at 3

years was 26% for the entire group, 30% in the younger group, 28% in the intermediate

group, and 9% in the elderly group.

At the Christie Hospital in Manchester, UK, a retrospective review was performed in

patients who received cyclophosphamide-doxorubicin-etoposide chemotherapy in the

period 1994–98. The investigation compared patients treated on and off trial with the

same standard-arm treatment regimen. Sixty patients were treated in one of the two

randomized trials and 46 patients were treated off trial. Analysis of the data demonstrated

that survival was no different for patients participating in a randomized trial compared

with a group of patients similarly treated who were not eligible for trial or who declined

randomization