Pneumologie 2013; 67 - P24
DOI: 10.1055/s-0033-1345062

The TYROL Study SCLC Project: retrospective analysis of clinical features and therapeutic outcome in 484 small cell lung cancer patients diagnosed 1991 – 2011

M Fiegl 1, A Pircher 1, C Waldthaler 1, W Sterlacci 2, H Jamnig 3, T Schmid 4, M Nevinny 5, G Pall 6, W Oberaigner 7, G Zangerl 8, A Zabernigg 9, W Hilbe 1
  • 1Department of Internal Medicine V, Hemato/Oncology, Medical University Innsbruck
  • 2Department of Pathology, Academic Hospital of Feldkirch
  • 3Department of Pneumology, Natters Hospital, Natters,
  • 4Department of Visceral and Thoracic Surgery, Medical University Innsbruck
  • 5Department of Radio-Oncology, Medical University Innsbruck
  • 6Department of Internal Medicine I, Oncology, Medical University Innsbruck
  • 7Institute of Epidemiology (TILAK), Innsbruck, Austria
  • 8Department of Internal Medicine, Hospital Zams, Zams, Austria
  • 9Department of Internal Medicine, Hospital Kufstein, Kufstein, Austria

Introduction: To achieve respective results with long time follow up and to depict cohorts with long term survival, we analysed consecutive SCLC cases treated in Innsbruck/Natters Comprehensive Cancer Center.

Methods: We retrospectively analysed all patients with SCLC with respect to multiple disease and therapy features aiming at describing this disease and treatments applied in consecutive lines in most possible detail.

Results: Of 484 patients, 326 (67%) were male. Extensive stage at diagnosis: 269/483 informative cases (56%), (former) smoker 316/323 (98%); unfavorable ECOG PS (≥2) 100/303 (33%); symptoms at initial diagnosis: hemoptysis 44/293 (15%), cough 165/299 (55%); dyspnoea 153/302 (51%); tumor pain 135/305 (44%); neurologic symptoms (incl. paraneoplasia) 69/314 (22%); hyponatremia (≤130 mmol/l)/SIADH 47/339 (14%); prior/present other malignancy 86/436 (20%). 27 patients (6%) did not receive any treatment. In the 406 evaluable patients with palliative therapy, overall response was 56% (CR 18%, PR 39%, PD 31%, interruption 5%, death under therapy 8%); however, best response (at any time during treatment) was 78%. ORR was dramatically inferior in patients with advanced stage, unfavorable PS, and elevated LDH (p < 0.001). Median PFS from start of palliative therapy, evaluable in 415 patients, was 6.9 months. PFS was slightly superior in women (p = 0.041), and clearly inferior in patients with elevated CRP (p = 0.011) and LDH levels (p < 0.001), unfavorable performance status (p = 0.001), and extensive disease stage (p < 0.001); median overall survival from start of palliative therapy, evaluable in 415 patients was 11.3 months: more interestingly, there is plateau of long term survivors (5-ys survival 9.3%), mainly attributable to radiochemotherapy in limited disease (n = 118, median OS 20.3 months, 5-ys survival 22%). LDH and CRP, and PS are simple parameters significantly predictive for OS (p < 0.001). Second line palliative therapy was administered in 206 patients (ORR 23%); third line, 93 patients (ORR 14%); fourth line, 26 patients (ORR 8%) and fifth line, 9 patients (ORR 0%).

Conclusion: We are working on the establishment of diagnostic and therapeutic algorithms for an optimized management in this unfavourable disease.