Evaluation of curative and palliative radiotherapy efficacy in extensive stage small cell lung cancer

OBJECTIVE: To evaluate the efficacy of curative and palliative radiotherapy in the treatment of extensive stage small cell lung cancer (E-SCLC), and compare therapy effect on survival with or without metastatic disease.

METHODS: From January 1998 through December 2004, 128 patients with E-SCLC were treated with radiotherapy and concomitants combined chemotherapy. Radical radiotherapy, consisting of approximately 60 Gy given in up to 30 fractions was performed in 53 (41.4%) of these patients. Others (58.6%) were treated with palliative dose radiotherapy. In all patients, chemotherapy was planned with cisplatin (80 mg/m2) intravenously (i.v.) on day 1, and etoposide (120 mg/m2) i.v. on days 1, 2 and 3, every 3 weeks for 3-6 cycles. Conventional follow-up of patients was conducted at Izmir Oncology Center, Izmir, Turkey. All results were evaluated statistically.

RESULTS: One hundred and twenty-four patients (96.9%) were males. The mean age was 58.49 (± 9.01), ranging from 37-78 years. Metastases were initially determined in 64 patients (50%). The median follow up of patients was 287.41 days and median survival was 354.87 days. One year survival rate was 35.8%, and 2-year survival rates was 16.9% in the radical radiotherapy group, while these rates were 26.6% and 8% in the others. According to the statistical findings; the gains in duration of median survival with the curative thoracic irradiation are 151.97 days in all 128 patients.

CONCLUSION: This study shows that curative radiotherapy at the primary tumor provides an additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This finding raises the question of whether treatment with radical thoracic radiotherapy with concomitant chemotherapy, consisting of first-line drugs, might be more beneficial and cost-effective as well as a less toxic treatment of E-SCLC.