LDH LEVEL IS A PROGNOSTIC FACTOR FOR SCLC

SCLC represents 15-20% of lung cancer cases in Germany, the researchers note; its frequency has been declining slightly over the past 20 years.

Lead author Dr. Andreas Hermes and colleagues from Grosshandsdorf Hospital reviewed patient characteristics, treatment patterns, and outcomes in an unselected contemporary population of 397 SCLC patients.

Extent of disease, performance status, and elevated lactate dehydrogenase serum levels significantly predicted overall survival in multivariate analyses, whereas age and gender did not.

At diagnosis between 2004 and 2008, 242 of the patients (61%) had extensive disease. Most patients - 197 of those with extensive disease, and all but two of the 155 with limited disease - received regimens with carboplatin and etoposide. Of those patients, 87% with limited disease and 76% with extensive disease received at least 4 cycles of chemotherapy.

Nearly three quarters of patients with limited disease (112, 72%) received consecutive thoracic radiotherapy, whereas only 13 patients (5%) with extensive disease received thoracic radiotherapy.

Among patients with limited disease, 61% achieved a partial response, 15% showed a complete response, 16% had stable disease, and 4% had progressive disease. For patients with extensive disease, there were partial responses in 65%, complete responses in 4%, stable disease in 12%, and progressive disease in 12%.

Median survival was 18.8 months with limited disease and 10.6 months with extensive disease. Median survival for patients with limited disease did not depend on their number of chemotherapy cycles, but patients with extensive disease had a longer median survival with 5 or 6 cycles of first-line therapy (14.9 months) than with up to 4 cycles (8.7 months).

"Overall survival in patients with limited disease SCLC seemed to be slightly shorter in our database compared to results published in randomized trials," the investigators note. "However, it is important to consider that our data were generated in a non-selected patient population, and not in highly selected patient groups who had been included in clinical trials on concurrent thoracic radiotherapy. Additionally, the relatively low number of patients who actually received concurrent thoracic radiotherapy might have contributed to the reported survival data."

"Future improvements at our center will include a more frequent referral to concurrent thoracic radiotherapy of patients with limited disease SCLC in good performance status and a more frequent use of prophylactic cranial irradiation in patients with extensive disease SCLC and complete or partial response on first-line chemotherapy," the authors conclude.

SOURCE: Abstract

Lung Cancer 2010.