Chest
Volume 99, Issue 6, June 1991, Pages 1425-1432
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Clinical Investigations
Journal Article
Long-term Survival and Toxicity in Small Cell Lung Cancer: Expanded Southwest Oncology Group Experience

https://doi.org/10.1378/chest.99.6.1425Get rights and content

The Southwest Oncology Group formed a database of 2,501 patients consecutively enrolled in small cell lung cancer (SCLC) trials since 1976. This report summarizes an analysis of this database to determine predictors of 2- and 5-year survival in limited stage disease (LD) and 1- and 2-year survival in extensive stage disease (ED). In addition, we analyzed the frequency of late recurrences, toxicity, and quality of life issues in the long-term survivors. For consecutive studies, ≥2-year survival in LD were 15 percent, 21 percent, 28 percent, and 43 percent; 5-year survivals were 5 percent, 9 percent, 8 percent, and 20 percent. In ED, ≥ 1-year survivals were 27 percent, 23 percent, 21 percent, and 42 percent; ≥2-year survivals were 6 percent, 5 percent, 3 percent, and 19 percent. Using the logistic regression multivariate model, independent favorable predictors of 5-year survival for patients accrued to our older LD trials were normal lactate dehydrogenase (LDH) values and good performance status. Therapy as employed in these trials was not an independent factor. However, if patients enrolled on more recent trials were included, 2-year predictors could be assessed. Therapy with concurrent chemoradiotherapy and female gender then became additional independent favorable predictors. In ED, a single metastatic site and a normal LHH value were favorable predictors of survival beyond 1 year. The retrospective review of 63 patients with LD who survived at least 5 years found 33 asymptomatic patients with no recurrent disease; 6 with recurrent SCLC, 3 of whom died; 7 who died of non-cancer-related causes or unknown causes; 3 who died of second primary lung cancer; and 14 alive with persistent central nervous system symptoms and signs, possibly due to prophylactic brain radiation as given in the first 3 trials. No increased incidence of this syndrome has yet been observed in subsequent trials. For ED patients, 25 of 51 survivors ≥2 years subsequently died of recurrent SCLC. The majority of the long-term survivors with ED (35 of 51) had either a single metastatic site or metastases limited to opposite side of the chest or regional nodes. Our multivariate models support the conclusion that aggressive combined modality, concurrent induction therapy, along with favorable prognostic variables, independently contribute to the improved long-term survival we have observed in LD. Longer follow-up is required to confirm that this improvement has occurred with less late toxicity.

Section snippets

Patients and Methods

The formation of the SCLC database of 2,501 eligible patients entered on consecutive SWOG trials from 1976 to 1986 is summarized elsewhere.9 For all patients, standard evaluation and staging criteria for the time period were employed. Radionuclide bone scans were required for all patients. Radionuclide brain and liver scans were required until 1982, and computed tomographic (CT) brain and body scans were required thereafter. Contralateral supraclavicular nodes and isolated pleural effusion were

Logistic Regression and Long-term Survival Analyses for LD

The long-term survival percentages and results of the logistic regression analyses for the 1,363 eligible patients enrolled on SWOG LD studies are shown in Tables 2 and 3, respectively. Study 8269 (concurrent chemoradiotherapy) and superior 2- and 5-year survival compared with the three preceding trials.10 In the first logistic regression model (Table 3), which analyzed predictors of 5-year survival, all patients had to have a chance of survival for at least 5 years. Thus, the majority of

Discussion

This analysis of second-generation SCLC trials of the SWOG documented improvement in long-term survival without subsequent recurrence or persistent toxicity in the majority of patients with LD and in a few patients with ED. Overall, we observed that 24 percent of patients with LD survived ≥2 years and 7 percent survived ≥5 years. In the ED population, 23 percent lived ≥1 year, 4 percent lived ≥2 years, and 1 percent lived ≥5 years. Our first group-wide study of 373 patients that opened in 1974

Appendix

The following served as principal investigators for the SWOG studies analyzed in this manuscript: J. Blasko, G. Friess, P. Giri, B. Griffin, G. Goodman, B. Hom, L. Janaki, M. Kies, E Kim, J. D. McCracken, T. Miller, J. Mira, R. O'Bryan, C. Taylor, S. Taylor, and S. Williamson.

ACKNOWLEDGMENTS

We wish to thank the many SWOG members for contribution of patients to these trials, Gloria Chambers for assistance in preparing the database, Richard Fisher, M. D., for helpful comments, and Caroline Fazio for her preparation of the manuscript.

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    This investigation was supported in part by DHS Cooperative Agreement grants CA-46282, CA-37429, CA-20319, and CA-32102 awarded by the National Cancer Institute, DHHS. The principal investigators for the studies analyzed are acknowledged in the appendix.

    Manuscript received September 19; revision accepted November 6.

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