Staging and clinical prognostic factors for small-cell lung cancer

The two-stage system introduced by the Veterans' Affairs Lung Study Group c ontinues to be widely utilized in small-cell lung cancer (SCLC), mainly bec ause of its simplicity and clinical utility. Approximately one third of pat ients with SCLC present with limited-stage disease, which is defined as dis ease that can be encompassed in a tolerable radiation field. However, this definition is controversial when it is applied to the staging classificatio n of patients with locoregionally advanced disease manifested as the presen ce of an ipsilateral pleural effusion, contralateral supraclavicular lymph adenopathy, or contralateral mediastinal lymphadenopathy. The more descript ive TNM system is useful for patients with disease limited to the lung, whe n surgical resection may be feasible; this occurs in far less than 10% of c ases. As shown by clinical studies and autopsy data, metastatic disease fre quently involves the liver, adrenals, bone, bone marrow, and brain. History and physical examination, complete blood count and chemistry studies, ches t x-ray studies, computed tomography of the chest or upper abdomen, compute d tomographic scanning or magnetic resonance imaging of the brain, and bone scans are recommended for the pretreatment evaluation of patients with SCL C. A bone marrow biopsy may be omitted for patients with normal blood count s, normal lactate dehydrogenase level, and negative result on bone scan. Th e use of new imaging modalities, such as magnetic resonance imaging of the bone marrow and positron emission tomographic, scanning, may optimize stagi ng evaluation. Multiple prognostic parameters have been identified for pati ents with SCLC, the most important of which are the stage or extent of dise ase, performance status, serum lactate dehydrogenase level, and male gender . identification of risk factors for treatment-related mortality is Importa nt for the management of patients with SCLC.