Chemotherapy for small cell lung carcinoma: the Greenlane Hospital experience 1993-1995.

AIMS

1. To compare treatment response and survival of patients with small cell lung carcinoma managed at Greenlane Hospital with published results. 2. To compare the outcome of patients with extensive disease treated with oral etoposide with those who received combination chemotherapy.

METHODS

Case notes of all new patients assessed for small cell lung carcinoma between 1993 and 1995 were reviewed.

RESULTS

Seventy-eight cases were identified. Sixty-three patients (81%) underwent chemotherapy, of whom 32 had limited disease, 28 extensive disease and three were inadequately staged. Twenty-six patients (81%) with limited disease received combination treatment (carboplatin, etoposide +/- vincristine) compared with 16 (57%) in the extensive disease group. Response rate was significantly higher in those with limited disease (87.5%) than with extensive disease (50%), (p = 0.006). Overall median survival was 56 weeks in the limited disease group and 32 weeks for extensive disease (p = 0.007). Of patients with limited disease who achieved complete or partial response, 41% (n = 9) developed cerebral metastases as the first sign of disease relapse. These patients relapsed late (mean = 56 weeks) compared with those who relapsed at other sites (31 weeks) (p = 0.002). Patients with extensive disease, who received more than one drug (n = 16), had better median survival than those treated with etoposide only (n = 8), 35 vs 12 weeks, respectively (p = 0.6). Severe treatment complications were uncommon in either group. Four patients required admissions for infection although none were neutropenic. Only one patient (12.5%) treated with etoposide and three (18%) with combination chemotherapy developed grade IV neutropenia.

CONCLUSIONS

1. The survival in our series was comparable with published data on other treatment regimes. 2. Patients with extensive disease who received etoposide only had poorer median survival compared with those treated with more than one drug. This is likely a result of selection bias and the role of etoposide in palliation needs to be further assessed. 3. In spite of achieving good local control in patients with limited disease, late relapse with cerebral metastases was common. Prophylactic cranial irradiation, particularly in responders, needs to be considered in planning future treatment strategies. Small cell lung carcinoma (SCLC) accounts for 15-20% of all primary lung carcinomas and has an aggressive natural history because of its short tumour-doubling time and early metastatic potential. Chemotherapy has been used as the primary treatment modality for SCLC at Greenlane Hospital since 1979. Carboplatin, etoposide and vincristine (CEV) is an effective combination for patients with limited disease and has been adopted as the standard regime at Greenlane Hospital since 1993. Oral etoposide has attracted attention as a single agent for palliation in patients with advanced small cell lung carcinoma. Aggressive chemotherapy may not be appropriate in these patients whose prognosis is poor in spite of treatment. Etoposide offers the advantage of being an active oral agent and avoids the need for repeated venous access. It has been perceived as less toxic than other regimes and thus a preferred option for frail patients with extensive disease. The aims of this study were to compare treatment response and survival of patients with small cell lung carcinoma treated in our service since the introduction of the CEV regime with published data and to compare the outcome of patients with extensive disease treated with combination chemotherapy with those who receive oral etoposide only.