Background: Small-cell lung carcinoma (SCLC) is an aggressive form of lung cancer. Therapeutic strategies are chemotherapy (CT), radiotherapy (RT) and supportive care. The objective of our study was to investigate the epidemiologoical and clinicopathologic characteristics, therapy methods and prognosis of SCLC.
Methods: We conducted a retrospective study of 70 cases of SCLC collected in the department of medical oncology of Salah Azaiz institute in Tunis over a period of 6 years (2010-2015).
Results: The study population comprised 66 men and 4 women. The mean age was 58 years [34-88]. All patients were smokers. At presentation, the vast majority of patients were symptomatic. Pathological diagnosis was obtained essentially by the performance of bronchoscopic biopsy. It revealed a lung small cell neuroendocrine carcinoma. Fifty percent of tumors were immunoreactive for TTF-1, 90℅ for keratin and 73℅ for EMA. Tumors cells stained positively for markers of neuroendocrine differentiation including chromogranin A, synaptophysin and CD56. The disease was metastatic in 75℅ of cases. According to the VALCSG classification, the tumor was staged as limited-stage disease in 15 cases and extensive-stage disease in 55 cases. Thirteen patients received a curative –intent CT : 10 patients had induction CT before RT and 3 patients had concomitant radio-chemotherapy (RCT). Etoposide with cisplatin (EP) was the used regimen. The median overall survival (OS) in the limited-stage disease (LD) group was 16 months and the median progression free survival (PFS) was 13 months. Eighty two percent of patients with extensive-stage disease(ED) received palliative chemotherapy. The main regimens were EP, etoposide with carboplatin and CAV (cyclophosphamide, doxorubicin and vincristine). Seventeen patients received second line CT. Only 6 patients had third- line CT. A whole brain RT, thoracic RT, analgesic RT and RT of spinal cord compression were administrated in 35℅, 28℅, 11 ℅ and 6℅ of cases, respectively. The median OS in this group was 9 months and the median progression free survival was 4 months. Ninety one percent of patients received morphine. Thirty percent of patients were oxygen dependent. Evacuative thoracentesis was performed in 24 ℅ of cases. The median overall survival of the study population was 10.32 months.
Conclusion: Small cell lung cancer has poor prognosis. Developing prognosis biomarkers and experimenting new agents are needed to improve outcomes.
