Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
Lung Cancer. 2014 May;84(2):168-74. doi: 10.1016/j.lungcan.2014.02.005. Epub 2014 Feb 17.
It is not clear whether or not the fate of patients suffering from small-cell lung cancer (SCLC) has improved. To better understand the course of disease, we aimed at documenting disease features at initial diagnosis, sequences of therapy modalities and outcome in consecutive patients over two decades. We postulated that SCLC patients might have benefitted from refined diagnosis and treatment options during the last decade.
All SCLC cases diagnosed at the Innsbruck University Hospital and associated institutions between 1991 and 2011 have been documented in detail in accordance with a prespecified protocol.
A total of 484 patients diagnosed with SCLC were followed. The most important symptoms at initial diagnosis were cough, dyspnea and tumor pain in 55%, 51% and 44%, respectively. Patients who were operated during early stage of disease (n = 26) had a favorable 5-year, relapse-free survival (74%). A total of 112 patients with locally advanced disease were treated by radiochemotherapy in curative intent (RCT), and achievement of CR offered a chance of long term overall survival (OS), reaching 44% after 10-years. In the palliative setting (median OS in 304 evaluable patients, 9.7 months), a therapeutic progress in the more recent decade could not be observed. Parameters independently associated with favorable OS were: response to therapy and prophylactic brain irradiation in patients with RCT; and response, age < 70 years and absence of LDH elevation in the palliative setting.
In this comprehensive view on SCLC, the findings on symptomatology, comorbidity, and spectrum of treatments may help to better understand individual courses of the disease. Overall, modern medicine failed to translate into substantial benefit of SCLC patients, except in patients in locally advanced disease receiving multimodal therapy.
小细胞肺癌（SCLC）患者的命运是否有所改善尚不清楚。为了更好地了解疾病的进程，我们旨在记录 20 多年来连续患者的初始诊断时的疾病特征、治疗方式的顺序和结果。我们推测，在过去十年中，SCLC 患者可能从更精细的诊断和治疗选择中受益。
根据预设方案详细记录了 1991 年至 2011 年期间在因斯布鲁克大学医院和相关机构诊断为 SCLC 的所有病例。
共随访了 484 例 SCLC 患者。初始诊断时最重要的症状是咳嗽、呼吸困难和肿瘤疼痛，分别占 55%、51%和 44%。在疾病早期接受手术的患者（n = 26）5 年无复发生存率（74%）良好。共有 112 例局部晚期疾病患者接受根治性放化疗（RCT）治疗，达到完全缓解（CR）可提供长期总生存（OS）的机会，10 年后达到 44%。在姑息治疗（304 例可评估患者的中位 OS 为 9.7 个月）中，最近十年没有观察到治疗进展。与良好 OS 相关的独立参数是：RCT 中患者的治疗反应和预防性脑照射；以及姑息治疗中反应、年龄<70 岁和 LDH 不升高。
在这项对 SCLC 的综合研究中，关于症状、合并症和治疗方案的发现有助于更好地了解疾病的个体进程。总体而言，现代医学未能为 SCLC 患者带来实质性获益，除了接受多模式治疗的局部晚期疾病患者。
