Retrospective study of treatment results for limited-stage small-cell lung cancer in National Nishigunma Hospital

We retrospectively evaluated the treatment results of limited-stage small cell lung cancer (LS-SCLC) in National Nishigunma Hospital and indicated some problems when standard of radiation therapy for LS-SCLC was put into practice in our hospital. From February 1984 to October 2000,49 patients were newly diagnosed with LS-SCLC in National Nishigunma Hospital. All cases were confirmed as small-cell carcinoma by the histologic and cytologic findings. Patients consisted of 39 males and 10 females, the ages ranged from 46 to 87 years (mean, 66 years), Patients ≥75 years were 16%. There were 41 (84%) patients in Eastern Cooperative Oncology Group performance status (PS) 0 or 1 and 8 (16%) were in PS 2 or 3. All patients were treated with chemoradiotherapy. For thoracic radiation therapy (TRT), conventional once daily fractionation of 2.0 Gy was employed in principle, five patients were treated on a twice-daily schedule, and the average total doses were 48 Gy (30-60 Gy). In chemotherapy, all were treated with chemotherapy of various contents. For the first several years of this series, cyclophosphamide based chemotherapy and platinum based chemotherapy were mixed, but 41 of 49 patients were treated with platinum based chemotherapy from the late 1980s. The numbers of patients treated by concurrent and sequential chemoradiotherapy were 21 and 28, respectively. During this period, radiotherapy staff were insufficient. Part-time radiation oncologists treated patients twice a week with one or two radiotherapists by June in 1997. From July 1997, one full-time and another part-time radiation oncologists worked with the two radiotherapists. The median survival of the 49 patients was 22 months. The 2- and 5-year overall survival rates were 45% and 18%, respectively, and the 2- and 5- year cause specific survival rates were 51% and 20%, respectively. The 2- and 5-year disease free survival rates were 23% and 15%, respectively. The local and/or distant failure appeared in 80% of patients who could be confirmed. The initial failure site was within the radiation field in 26% patients, the brain in 15%, and 39% of the patients had tumor progression only outside the radiation field or both in-field and distant failures at the same time. Of the patients with a recurrence, 92% were detected within 20 months after treatment and recurrent lesions appeared in the last patients 48 months after treatment. Six patients (12%) had survived free of disease beyond 5 years. Only PS was statistically significant to cause specific survival rate by the log-rank test. Our treatment results were reasonable as a historical report. It is said that the most appropriate treatment for patients with LS-SCLC in good condition at this time is concurrent chemotherapy and TRT by accelerated hyperfractionated radiation therapy and prophylactic cranial irradiation (PCI) for complete responders. However we should be careful to apply these methods to patients of a middle-sized hospital in Japan because it is possible that there are some patients who have poor risk factors of survival or toxicities in non-selective patients. Another problem is that twice-daily radiotherapy could be a burden to radiotherapy staff because of an insufficiency of radiation oncologists and radiation therapists in these institutions. (author)