RISK OF LATE RECURRENCE AND OR 2ND LUNG-CANCER AFTER TREATMENT OF PATIENTS WITH SMALL-CELL LUNG-CANCER (SCLC)

The aim of this study was to illustrate some difficulties in distingui shing late recurrence of small cell lung cancer (SCLC), from second pr imary lung cancer. Three-hundred fourteen SCLC patients were observed at the Institute of Tuberculosis and Chest Diseases in Warsaw, during the period 1976-1985. All patients were treated with chemotherapy and 125 were also treated with radiotherapy on the tumour and mediastinum. Nineteen patients (6%) survived 3 years. This group consisted of eigh t females (9%) and 11 males (5%). In all of them a complete remission was obtained. In six patients from this group no progression of lung c ancer was observed. Four of them are still living, 7.9-16.2 years afte r the start of treatment. Two patients died of heart infarct. In the r emaining 13 patients, progression of SCLC or development of new cancer was noted in the course of observation. In seven of them, histologica l proof of the character of progression was obtained. In four cases no n-small cell lung cancer (NSCLC) was diagnosed after 3-11 years of obs ervation. In one of them SCLC metastases in the liver were unexpectedl y found in the autopsy, although adenocarcinoma in the lung diagnosed during bronchoscopy was also confirmed in the autopsy. In three cases SCLC was diagnosed. In one case, 2.7 years from the beginning of treat ment, only SCLC metastases were found during laparoscopy. SCLC was fou nd in two other cases after a 7-year cancer-free period. In one of tho se patients, a new lesion was found in the other lung while the second patient developed a new lesion exactly in the place of the former can cer. In six other patients no histological proof of the character of p rogression was obtained. Two of the six are still. living, 8.2 and 15. 1 years later. In the first of these two, a new lesion developed very early in the course of treatment in the same place as the primary tumo ur and it was regarded as the progression of SCLC. In the second patie nt, who probably had NSCLC the lesion developed in the contralateral l ung after 12.5 years of remission and disappeared after radiotherapy. Four patients died of cancer after 3.2-6.4 years of observation. The c umulative risk of a second primary lung cancer after a 3-year survival period oscillated in our SCLC patients between 4% and 6% for every pa tient/year of observation. It was concluded that prognosis in SCLC pat ients is still doubtful, nevertheless, some patients made a complete r ecovery.