Small cell carcinoma of the lung. A progress report of 15 years' experience

Abstract

To assess the results of therapeutic advances in the treatment of small cell carcinoma of the lung (SCCL) achieved during the past 15‐year period at a single large institution, 508 patients treated between 1968 and 1982 were divided into two groups: (1) 157 patients (66 in the category of limited‐stage disease and 91 in the extensive‐stage disease category) treated with low‐dose small‐volume radiotherapy (RT) (time dose fractionation [TDF] 49–66) and with cyclophosphamide alone or a COPP program during the first period of 7 years (1968–1974); (2) 351 patients (180 in limited and 171 in extensive stage) treated with multidrug chemotherapy (CT) and high‐dose large‐volume RT (TDF 73–89) during the second period of 8 years (1975–1982). For patients with limited‐stage cancer, 5‐year actuarial survivals were 3% versus 7% for the periods 1968–1974 versus 1975–1982, respectively, P < 0.01. For patients with extensive‐stage cancer, the median survival time (MST) and 2‐year actuarial survivals were 5 months and 2% versus 7 months and 4% for the periods 1968–1974 versus 1975–1982, respectively. To evaluate the outcome of a contemporary approach, i.e., CT alone, with RT reserved for locoregional failure, 180 patients with limited‐stage cancer who were treated (1975–1982) were further analyzed for MST, 2‐ and 5‐year actuarial survival figures, and local‐tumor control rates according to the therapeutic approaches employed: CT + RT (112); CT alone (36); RT alone (17); and surgery (S) ± CT ± RT (15). Although the 36 patients in CT alone seems a small number, 17 of the 36 patients were enrolled in this approach in 1981–1982, reflecting a shift of emphasis from RT to CT. The MST and 2‐year actuarial survival figures were 11 months and 0% versus 13 months and 21% for CT alone versus CT + RT respectively, P < 0.05. CT + RT achieved a 5‐year cure rate of 8%. S ± CT ± RT or RT alone also achieved 5‐year cure rates of 8% and 10.5%, respectively, in selected subsets of patients. Local relapse rates were 80% (29/36) versus 25% (28/112) for CT alone versus CT + RT. These data emphasize the importance of thoracic RT given at the early phase of treatment to improve long‐term survival for patients with limited‐stage SCCL. Cancer 59:6–14, 1987.