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Treatment of small cell lung cancer
Abstracts/Lung increases in age-adjusted rates were observed for small cell carcinoma end adcnocsrcinoma (epproximetcly 60% each), with a more modest change for squamous cell carcinoma (+14%). For squamous cell carcinoma, the age-adjusted rates increased substantially for black (65%) and white (70%) woman and only slightly for black men (10%). whereas it decreased slightly in rcccnt years for white men. Conclusions. In recent years, .sdcnocarcinoma has replaced squamous cell carcinoma as the most frequent histologic subtype for all scxcs and races combined. Thcsc shills in histologic types by sex and race may be rclatcd to differences in exposure to tobacco products, dietary factors, environmental or occupational carcinogens, and host characteristics. Increased USCof transbronchial and needle biopsy may have also influenced thcsc trends to scmc cxtcnt. Over the study period, 5-year relative survival rate did not change appreciably for lung canccr. suggesting that therapeutic advances have had little cffcct.
Cancer 12 (1995) 265-329
327
‘Ikatmeat of small cell bmgcaacer Ucoka H, Ohnoshi T. Second Deporbnenf of Medicine, Okayama University Medical School, 2-S-I Shikafa-cho, Okayama 700. Jpn J Cancer Chcmother 1994;21:2571-7. This paper overviews the recent treatment results for small cell lung cancer. The last decade has brought only a small improvement, supposedly, mainly due to the development of drug resistance. However, current trials of non-crossr&tat chemotherapy, dowintensive wakly chemotherapy, l&e intensification with autologous bone marrow transplantation, and combined modality treabnent with thomcic irradiation have shown a substantial advance in the tmabncnt of smell cell lung cancer. Becent cbaageof
management
in advanced
Kodsma N, Kawahsre M, Furuse K. Department
Extrapulmoaary small cell carcinoma: A rioglekwtitotioo experience aodreviewdtheliterature Lo Re G, Canzonieri V, Vcronesi A. Dal Bo V, Barzan L, Zancanaro C et al. Division o/Mcdcol Oncology Cfz Regionale Rijoimenfo Oncolog., INRCCS, Ko Pedemonfana Occle, I-33081 Aviano. Ann Oncol 1994;5:909-13. Bw&grmmd. Small cell carcinoma (XC) is a distinct pathologic entity that may also occur in extrapulmonary sitea. In this report ~JICrctrospeetive results of multimodal therapy of primitive extrapulmonary (I.$ SCC, in a single institution series, are presented. Me&o& Twenty-four patients (pts) with ESCC were referred to the Centro di Riftimento Oncologico, Aviano, Italy, from 1986 to 1992. Clinics-therapeutic findings were cvalusted in 20 pts. Their ages ranged from 20 to 87, with 8 median of 60.5 years. Primaly tumor sites were urinary bladder (5 pts), prostate (4 pts), larynx (3 pts), kidney (2 pts), ovary, skin, ampharynx, trachea, uterine cervix, cthmoid, and stomach (1 pt each); lymph node mctastascs of unknown origin were observed in 3 pts. More than 50% of pts presented extensive disease. Resulfs. Histologically, I6 cases were pure ESCCs and 8 cases were combined. 4 of them with adamcarcinoma, 2 with transitional cell carcinoma, and 2 with squamous cell carcinoma. Immunohistochemical stud& pcrformcd in 7 cases, demonstmtcd the cpithclial nature of these tumors. The cisplatin-VP16 (PE) rcgimcn was used in 13 pts, and 9 of them (69%) obtained objective responses after chemotherapy (CT) alone, with 3 complete remissions (CR) and 6 partial rcmiwions (PR). Median CR and PR duration was 13+ and 24 months, rcspcctivcly. Radiotherapy was performed in 7113 pts after induction CT and before consolidation CT. The objective response rate was loO%, with 6 CR and 1 PR. No severe toxic side effects and no toxic deaths were reported. A patient trcatcd with surgery alone for a urinary bladder tumor showed continuous long-m survival, while 1 of 2 pts treated with radiotherapy alone obtained PR. Conclusions. The PE regimen has an activity similar to the one observed in pulmonary SCC.
Branchial sod thymic carchmid tumon: A rekw Dusmct M, McKncally MF. Division of Thonzcic Surges The Toronfo Hospifal, 200 Elizabefh Sfrvef, Tomnfo, Onf. h45G 2C4. Digestion 1994;55:Suppl3:706. Bronchial carcinoid tumors arc usually indolent, slow-growing hrmors with an excellent prognosis. However, even typical carcinoids can mctastazisc to regional lymph nodea or to distant sites. Atypical carcinoids tend to behave more invasivcly with ma-c frcqucnt nodal and distant metastwx. Despite this, longtcmr survival can be expected as many tumors grow end spread slowly. At the end of the spectrum are the highly aggressive small cell carcinomas which have a very poor prognosis despite aggressive chemotherapy. Clinically, car&mid tumors arc frcqucntly asymptomatic. Symptoms arc most frcqucntly due to obstruction (pneumonia, ‘asthma’, coughing) or bleeding. Carcinoid syndrome is seen infrcqucntly and usually signifies mctastatic discax Gushing’s syndrome is occasionally seen in association with these tumors. The treatment of carcinoid hlmors is surgical. Rex&ion should be complete and cncompsss the regional lymph node?..
ooo-small
cell hmgcaocer Nu&ional Sabi 591. Jpn J
of InfernalMedicine,
Kinhi Cenbal Hospifal, Chest Disease, 1180 Nagwow-cho. Cancer Chemother 1994;21:2564-2570. The value of chemotherapy in advanced non-small cell lung cancer (NSCLC) has ban shown in combination chemotherapy with cisplatin, which yields only marginal survival benefits. Chcmoradiothcrapy with cisplatin improves the survival of patients who have unrcscctablc, locally advanced NSCLC when compared with the treatment by radiation therapy alone. The 2- and 3-year survival rates arc nearly doubled on evcragc. Ncoadjuvant chemotherapy is more effective than surgery alone for the treatment of stage EtA NSCLC in the randomized phase lJJl trials. It is suggested that ncoadjuvant chcmothcrapy will be a standard therapy for stage fUA NSCLC which is marginally resectable. There are many studies about radiation methods such as hyperfractionatcd radiation therapy and CHART, irradiated dose, and timing of radiation. There is e need to develop new, more active anticancer agents, and to find more effective regimens.
Future directions in clinical research for hmgcaacer Bunn PA Jr. Box B18.8. 4200 E 9th. Denver, CO 80262. Chest 1994:106, Suppl:399S-407S. Even since the Surgeon General’s 1964 report, the mortality rate fmm lung cancer has continued to rise. Although there is evidence that this continued increase in mortality will slow or level in the next decade, lung cancer motility is a major health problem destined to remain with us for at least the next generation. There have been no established advances in the early d&&ion or prevention of lung cancer in the last 30 years and our therapies have increased the cure rate only from 5 to 13% in this 30-year interval. Biologic advances have outpaced clinical advances in recent times and many of the adv~ccs arc now ripe for clinical exploitation. There are currently more exciting clinical trials for all phases of lung cancer than at any time and it till be stimulating to wihxss the results of the clinical trials discussed herein. Hopefully, the results of these studies will lead to a decreusc in lung cancer mortality in the next cenhuy, much as it increased in the past century. Ev~atioadtbetberapeutkp~osisandlong-tena sarviwrsdsmaU cell lung cancer Nskayama H, Yokoyama A, Kinamcri K, Kurita Y. Deparbnenf o/Infernal Medicine, Niigafo Cancer Cenfer Hospiral, Niigafa. Lung Cancer (Japan) 1994;34:867-74. The thcrapcutic prognosis and long-term survival wcrc evaluated in 207 patients with small cell lung cancer who were treated after October, 1982. There were 121 patients with limited disease (LD) and 86 with extensive disease (ED). Rcscction was perfomxd in 19% of the casts and 44% were treated with LLcombination of chemotherapy and radiotherapy. Comparmg induction chemotherapy @CT, 2S cases) and adjuvant chemotherapy (I2 cases), ICT was superior in median survival time (MST, 36,29 months, respectively) and J-year survival (3YS, 57,45%, respectively). There was no difference in MST and 3YS (14, 18%, rcspcctively) bchvecn the concurrent (7 cases) and sequential method (22 cases) of radiotherapy. The combination chemotherapy of CDDP, ADM and VP-16 with G-CSF for patients with ED had B longer MST (22 months) and bcttcr 3YS (21%) than those without C-CSF. Of 24 long-term survivors (greater than 3 years), 21 patients had LD and 3 had ED. Thirteen patients underwent surgical rcscction. There were 6 CR and 4 PR among 10 SCLC patients who received chemotherapy and radiotherapy. Now 5 are alive and disease free for more than 5 years. One patient had a second cancer. ICT for surgical patients and dose intensive chemotherapy for patients with ED seemed to improve survival rate, but there was no statistically significant difference.
Cancer 12 (1995) 265-329
327
‘Ikatmeat of small cell bmgcaacer Ucoka H, Ohnoshi T. Second Deporbnenf of Medicine, Okayama University Medical School, 2-S-I Shikafa-cho, Okayama 700. Jpn J Cancer Chcmother 1994;21:2571-7. This paper overviews the recent treatment results for small cell lung cancer. The last decade has brought only a small improvement, supposedly, mainly due to the development of drug resistance. However, current trials of non-crossr&tat chemotherapy, dowintensive wakly chemotherapy, l&e intensification with autologous bone marrow transplantation, and combined modality treabnent with thomcic irradiation have shown a substantial advance in the tmabncnt of smell cell lung cancer. Becent cbaageof
management
in advanced
Kodsma N, Kawahsre M, Furuse K. Department
Extrapulmoaary small cell carcinoma: A rioglekwtitotioo experience aodreviewdtheliterature Lo Re G, Canzonieri V, Vcronesi A. Dal Bo V, Barzan L, Zancanaro C et al. Division o/Mcdcol Oncology Cfz Regionale Rijoimenfo Oncolog., INRCCS, Ko Pedemonfana Occle, I-33081 Aviano. Ann Oncol 1994;5:909-13. Bw&grmmd. Small cell carcinoma (XC) is a distinct pathologic entity that may also occur in extrapulmonary sitea. In this report ~JICrctrospeetive results of multimodal therapy of primitive extrapulmonary (I.$ SCC, in a single institution series, are presented. Me&o& Twenty-four patients (pts) with ESCC were referred to the Centro di Riftimento Oncologico, Aviano, Italy, from 1986 to 1992. Clinics-therapeutic findings were cvalusted in 20 pts. Their ages ranged from 20 to 87, with 8 median of 60.5 years. Primaly tumor sites were urinary bladder (5 pts), prostate (4 pts), larynx (3 pts), kidney (2 pts), ovary, skin, ampharynx, trachea, uterine cervix, cthmoid, and stomach (1 pt each); lymph node mctastascs of unknown origin were observed in 3 pts. More than 50% of pts presented extensive disease. Resulfs. Histologically, I6 cases were pure ESCCs and 8 cases were combined. 4 of them with adamcarcinoma, 2 with transitional cell carcinoma, and 2 with squamous cell carcinoma. Immunohistochemical stud& pcrformcd in 7 cases, demonstmtcd the cpithclial nature of these tumors. The cisplatin-VP16 (PE) rcgimcn was used in 13 pts, and 9 of them (69%) obtained objective responses after chemotherapy (CT) alone, with 3 complete remissions (CR) and 6 partial rcmiwions (PR). Median CR and PR duration was 13+ and 24 months, rcspcctivcly. Radiotherapy was performed in 7113 pts after induction CT and before consolidation CT. The objective response rate was loO%, with 6 CR and 1 PR. No severe toxic side effects and no toxic deaths were reported. A patient trcatcd with surgery alone for a urinary bladder tumor showed continuous long-m survival, while 1 of 2 pts treated with radiotherapy alone obtained PR. Conclusions. The PE regimen has an activity similar to the one observed in pulmonary SCC.
Branchial sod thymic carchmid tumon: A rekw Dusmct M, McKncally MF. Division of Thonzcic Surges The Toronfo Hospifal, 200 Elizabefh Sfrvef, Tomnfo, Onf. h45G 2C4. Digestion 1994;55:Suppl3:706. Bronchial carcinoid tumors arc usually indolent, slow-growing hrmors with an excellent prognosis. However, even typical carcinoids can mctastazisc to regional lymph nodea or to distant sites. Atypical carcinoids tend to behave more invasivcly with ma-c frcqucnt nodal and distant metastwx. Despite this, longtcmr survival can be expected as many tumors grow end spread slowly. At the end of the spectrum are the highly aggressive small cell carcinomas which have a very poor prognosis despite aggressive chemotherapy. Clinically, car&mid tumors arc frcqucntly asymptomatic. Symptoms arc most frcqucntly due to obstruction (pneumonia, ‘asthma’, coughing) or bleeding. Carcinoid syndrome is seen infrcqucntly and usually signifies mctastatic discax Gushing’s syndrome is occasionally seen in association with these tumors. The treatment of carcinoid hlmors is surgical. Rex&ion should be complete and cncompsss the regional lymph node?..
ooo-small
cell hmgcaocer Nu&ional Sabi 591. Jpn J
of InfernalMedicine,
Kinhi Cenbal Hospifal, Chest Disease, 1180 Nagwow-cho. Cancer Chemother 1994;21:2564-2570. The value of chemotherapy in advanced non-small cell lung cancer (NSCLC) has ban shown in combination chemotherapy with cisplatin, which yields only marginal survival benefits. Chcmoradiothcrapy with cisplatin improves the survival of patients who have unrcscctablc, locally advanced NSCLC when compared with the treatment by radiation therapy alone. The 2- and 3-year survival rates arc nearly doubled on evcragc. Ncoadjuvant chemotherapy is more effective than surgery alone for the treatment of stage EtA NSCLC in the randomized phase lJJl trials. It is suggested that ncoadjuvant chcmothcrapy will be a standard therapy for stage fUA NSCLC which is marginally resectable. There are many studies about radiation methods such as hyperfractionatcd radiation therapy and CHART, irradiated dose, and timing of radiation. There is e need to develop new, more active anticancer agents, and to find more effective regimens.
Future directions in clinical research for hmgcaacer Bunn PA Jr. Box B18.8. 4200 E 9th. Denver, CO 80262. Chest 1994:106, Suppl:399S-407S. Even since the Surgeon General’s 1964 report, the mortality rate fmm lung cancer has continued to rise. Although there is evidence that this continued increase in mortality will slow or level in the next decade, lung cancer motility is a major health problem destined to remain with us for at least the next generation. There have been no established advances in the early d&&ion or prevention of lung cancer in the last 30 years and our therapies have increased the cure rate only from 5 to 13% in this 30-year interval. Biologic advances have outpaced clinical advances in recent times and many of the adv~ccs arc now ripe for clinical exploitation. There are currently more exciting clinical trials for all phases of lung cancer than at any time and it till be stimulating to wihxss the results of the clinical trials discussed herein. Hopefully, the results of these studies will lead to a decreusc in lung cancer mortality in the next cenhuy, much as it increased in the past century. Ev~atioadtbetberapeutkp~osisandlong-tena sarviwrsdsmaU cell lung cancer Nskayama H, Yokoyama A, Kinamcri K, Kurita Y. Deparbnenf o/Infernal Medicine, Niigafo Cancer Cenfer Hospiral, Niigafa. Lung Cancer (Japan) 1994;34:867-74. The thcrapcutic prognosis and long-term survival wcrc evaluated in 207 patients with small cell lung cancer who were treated after October, 1982. There were 121 patients with limited disease (LD) and 86 with extensive disease (ED). Rcscction was perfomxd in 19% of the casts and 44% were treated with LLcombination of chemotherapy and radiotherapy. Comparmg induction chemotherapy @CT, 2S cases) and adjuvant chemotherapy (I2 cases), ICT was superior in median survival time (MST, 36,29 months, respectively) and J-year survival (3YS, 57,45%, respectively). There was no difference in MST and 3YS (14, 18%, rcspcctively) bchvecn the concurrent (7 cases) and sequential method (22 cases) of radiotherapy. The combination chemotherapy of CDDP, ADM and VP-16 with G-CSF for patients with ED had B longer MST (22 months) and bcttcr 3YS (21%) than those without C-CSF. Of 24 long-term survivors (greater than 3 years), 21 patients had LD and 3 had ED. Thirteen patients underwent surgical rcscction. There were 6 CR and 4 PR among 10 SCLC patients who received chemotherapy and radiotherapy. Now 5 are alive and disease free for more than 5 years. One patient had a second cancer. ICT for surgical patients and dose intensive chemotherapy for patients with ED seemed to improve survival rate, but there was no statistically significant difference.