Survival and patterns of relapse following treatment of small-cell lung cancer at a community cancer center.

BACKGROUND: Although data from previously published trials have suggested an incremental improvement in response rate and survival in patients with small-cell lung cancer, few of these trials originate from private practice/community cancer center settings. The outcomes of patients with small-cell lung cancer treated in such a practice setting are reviewed and compared to prior studies with particular attention to the potential role of prophylactic cranial irradiation (PCI). METHODS: One hundred eighty patients treated between 1988 and 1998 comprise the basis of this analysis. In each individual, the specifics of therapy were recorded as well as the best response, sites of relapse, and survival. RESULTS: The disease was limited in extent (LD) in 99 patients (55%) and extensive (ED) in 81 (45%). The overall/complete response rates for LD patients and ED patients respectively were 90.9%/72.7% and 61.7%/18.5%. Median survivals for LD and ED patients were 20.2 and 9.59 months respectively. The one-year, two-year, and five-year actual survival rates for the entire group were 59.1%, 22.2%, and 8.7%. Central nervous system relapses occurred in 42.9% of this largely nonprophylactic cranial irradiation treated patient population. The central nervous system was the only site of relapse in 13.6%. CONCLUSIONS: The outcomes of patients treated in this private practice/community cancer center setting are similar to those previously published from single university and multi-institutional studies. Although these data support the use of cranial irradiation in patients who achieve a complete response, the impact of such an intervention will remain relatively insignificant until there is an improvement in systemic therapy.