LONG-TERM SURVIVORS OF SMALL-CELL LUNG-CANCER (SCLC) - A FRENCH MULTICENTER STUDY

Background: The aim of this study was to analyze SCLC patients beyond 30 months, particularly their outcome, their way of life, and Factors which could influence relapses, second-primary cancers and death. Pati ents and methods: Between January 1986 and May 1995, 263 SCLC patients who survived longer than 30 months were included from 52 French insti tutions. The analysis was performed on the 155 cases confirmed by a pa thologic review. Results: Physical, mental and psychological states we re considered as normal at 30 months in respectively 70.3%, 87.7% and 67.7% of patients, not influenced by prophylactic cranial irradiation, number of chemotherapy cycles, CCNU or cisplatin. Therapeutic sequela e were neurological impairment (13%), pulmonary fibrosis (18%) and car diac disorders (11%) at 30 months. Return to work was possible for 40% of patients in the first two years following diagnosis. Among 43 rela psing patients, 33 benefited from a second-line treatment. Their media n survival was 12 months since retreatment, and seven patients have su rvived again longer than 30 months. Age > 60 at the time of diagnosis was found as an independent factor increasing the risk of relapse beyo nd 30 months (OR = 2.46, IC 95% (1.16-5.26), P = 0.01). The risk of re lapse became less than 10% beyond five years. Twenty patients (13%) de veloped a second primary cancer in a mean time of 58.6 months. The ris k of second primary cancer was increased by a number of chemotherapy c ycles > 6 (OR = 3.25, IC 95% (1.08-9.8) P = 0.02) and by an age > 60 ( OR = 2.92, IC 95% (1.07-7.97), P = 0.03). Five-and 10-year survival ra tes were respectively 68% and 44%. In these patients having reached a 30-month survival, three independent factors were predictive of a surv ival longer than five years: age less than or equal to 60 at the time of diagnosis (OR = 2.85, IC 95% (1.23-6.6), P = 0.01), chest radiother apy (OR = 3.1, IC 95% (1.28-7.69), P = 0.006) and absence of relapse ( OR = 4.5, IC 95% (1.75-12.5), P = 0.002). This study suggests that: 1) therapeutic sequelae are rather mild, allowing return to work in 40% of patients; 2) relapsing 30-month survivors can benefit from second-l ine treatment; 3) SCLC cure can be achieved with a 10-year follow-up.