OUTCOME OF PATIENTS WITH SMALL-CELL LUNG-CANCER DURING 20 YEARS OF CLINICAL RESEARCH AT THE US NATIONAL-CANCER-INSTITUTE

Objective: To determine the outcome of all patients with small-cell lu ng cancer (SCLC) treated at the US National Cancer Institute between A pril 1973 and April 1993. Design: We retrospectively analyzed a series of 594 consecutive patients with SCLC treated at a single institution during a 20-year period to assess changes in duration of survival and toxicity related to various treatment regimens. Material and Methods: For analysis, patients were grouped by decade, and the duration of su rvival of patients with limited-and extensive-stage SCLC was examined to assess whether patients treated during the first decade of the stud y (1973 through 1983), when cyclophosphamide-based regimens were used, had different outcomes than those treated during the second decade (1 983 through 1993), when cisplatin-based regimens were used. Patients h ad a minimal follow-up of 2 years. Results: No significant difference was found in the survival of patients with limited-or extensive-stage SCLC treated during the second decade in comparison with during the fi rst decade of the study. Among patients with extensive-stage SCLC, per formance status 3 or 4 and metastatic lesions of the liver and central nervous system had a significant adverse effect on survival in both t he first and the second decade. Among patients with limited-stage dise ase, performance status 3 or 4 had the most significant adverse influe nce on survival during the overall study period. In addition, in a mul tivariate analysis, etoposide-cisplatin plus twice-daily chest radioth erapy was significantly associated with prolonged survival (P = 0.003) . Conclusion: We noted no significant change in the duration of surviv al of patients with either limited-or extensive-stage SCLC treated at our institution during a 20-year period. A multivariate analysis showe d that patients with limited-stage SCLC given a cisplatin-based regime n plus chest radiotherapy lived modestly longer than similar patients given cyclophosphamide regimens at our institution. No evidence was fo und of changes in pretreatment factors that would affect survival.