Limited-stage small-cell lung cancer (stages I-III): Observations from the National Cancer Data Base

Academic Article

Abstract

  • The standard treatment of limited-stage small-cell lung cancer (LS-SCLC) has changed over the past 15 years. Standard treatment for LS-SCLC currently involves multiple-agent chemotherapy and early concurrent thoracic radiation therapy. Four patient cohorts (total number of patients, 22,969) diagnosed with LS-SCLC in 1985 (N = 2123), 1990 (N = 6279), 1995 (N = 7815), and 2000 (N = 6752) were studied in order to describe demographic and treatment pattern changes as well as 5-year survival rates across cohorts. Women composed 40.2% of patients in the 1985 cohort but represented a significant proportional increase over each successive cohort, representing 50.8% of the 2000 cohort. The proportion of patients aged ≥ 70 years also significantly increased over time, from 31.6% in 1985 to 44.9% in 2000 (P < 0.001). Over these years, the use of chemoradiation as the primary treatment for patients with LS-SCLC increased from 34.6% to 51.9% (from 37% to 60.5% for patients aged < 70 years, and from 29.5% to 41.3% for patients aged ≥ 70 years). During the same time, the use of chemotherapy as the sole treatment decreased from 30.7% in 1985 to 21.7% in 2000. Chemotherapy as the sole treatment was used in 25.9% of the population ≥ 70 years of age in 2000, compared with 18.3% in patients aged < 70 years. The percent of patients for which there was no treatment given did not change significantly between the cohorts (14.3% in 1985 and 13.7% in 2000; P < 0.001). The 5-year survival rates and 95% confidence intervals (CIs) for the 1985, 1990, and 1995 cohorts of all ages of patients treated with chemoradiation therapy are as follows: 10.5% (CI, 6.75%-14.25%), 11.88% (CI, 9.63%-14.13%), and 13.3% (CI, 11.2%-15.4%). Between 1985 and 2000 there was a significant increase in the percentage of women diagnosed with LS-SCLC. The use of combined chemotherapy and radiation therapy also increased during this period. This increase in chemoradiation therapy was associated with a decreased use of chemotherapy alone. Despite changes in demographics and treatment during these time intervals, the 5-year survival for patients with LS-SCLC treated with chemoradiation therapy did not increase significantly. These results demonstrate the continued need for the evaluation of new treatments in this group of patients.
  • Published In

    Digital Object Identifier (doi)

    Pubmed Id

  • 12200451
  • Author List

  • Gaspar LE; Gay EG; Crawford J; Putnam JB; Herbst RS; Bonner JA
  • Start Page

  • 355
  • End Page

  • 360
  • Volume

  • 6
  • Issue

  • 6