LONG-TERM SURVIVAL IN METASTATIC SMALL

UNIVERSITÄTSKLINIKUM
Schleswig-Holstein
Klinik für Radioonkologie
LONG-TERM SURVIVAL IN METASTATIC SMALL-CELL
LUNG CANCER (SCLC). A Case Report.
Gruen A1 Schultze J1, Kimmig B1
1Klinik
für Strahlentherapie (Radioonkologie)
Universitätsklinikum Schleswig-Holstein
Campus Kiel
Kiel
DEGRO 2009 Bremen
P 96
UNIVERSITÄTSKLINIKUM
Schleswig-Holstein
Klinik für Radioonkologie
Background:
Metastatic small-cell lung cancer (SCLC) has a poor prognosis. NCI SEER
statistics review 1975-2004 estimates the 5 year relative survival rates for
distant metastatic SCLC in white males aged 65 – 74 years at 3.9%, for distant
metastatic disease independent of age at 1.4%. Good performance status,
surgical resectability, chemotherapy and adjuvant whole brain radiation therapy
(WBRT) as well as normal LDH-values (Albain et al.) are among the predictors
for prolonged survival. Multiple bilateral brain-metastases are deemed as a
poor prognostic indicator (Hall, 2000). A poor overall performance status, an
age older than 63 years at time of diagnosis and a high Chromogranin A (CgA)
level especially in patients receiving conventional chemotherapy consisting of
cisplatin- and etoposid-based combinations are independent predictors of poor
prognosis (Pujol, 2003).
The shortest survival time allowing prediction of significant risk-reduction of
recurrence or death from SCLC is 3 years (Lewinski et al.)
DEGRO 2009 Bremen
P 96
UNIVERSITÄTSKLINIKUM
Schleswig-Holstein
Klinik für Radioonkologie
Patient/ Methods:
We report of a 69 year old male with a 6 year history
of distant metastatic small cell lung cancer (SCLC). At
age 65 the patient was diagnosed with a 2cm SCLC in
the left lower lung lobe. Mediastinal lymphomas up to
5cm in size were found near the ipsilateral hilus,
subcarinally and paratracheally. Diagnosis was
veridfied by endoscopic biopsy. The tumor was weakly
positive for Kl1. CD45 and chromogranin were
negative. MRI scan of the brain showed two small
bilateral metastases. A bone scan showed no sign of
further metastatic disease. LDH-levels were only
mildly elevated. There was no known history of
granulomatous lung disease. The patient received
neoadjuvant chemotherapy consisting of 6 cycles of
carboplatin/ etoposide followed by conventional
radiotherapy with 50 Gy to the mediastinum with 2 Gy
per fraction (fig. 1) and a whole-brain radiation therapy
(WBRT) with 40 Gy in 2 Gy fractions.
Figure 1
DEGRO 2009 Bremen
P 96
UNIVERSITÄTSKLINIKUM
Schleswig-Holstein
Klinik für Radioonkologie
Patient/ Methods (continued):
The patient showed a good overall performance status throughout the whole
therapy.
Results: CT- and MRI-based restaging of the chest and brain after induction
chemotherapy showed good response with regression in both the mediastinal
lymphomas and the brain lesions. A bone scan showed no sign of further
metastatic disease. Since the overall performance status was good the patient
could be kept as an outpatient throughout the whole therapy.
Today after 6 years of follow-up the patient has a good overall performance
status showing no signs of recurrent or progressive disease.
DEGRO 2009 Bremen
P 96
UNIVERSITÄTSKLINIKUM
Schleswig-Holstein
Klinik für Radioonkologie
Conclusion:
Although diagnosed with poor-prognosis systemically advanced small-cell lung
cancer (SCLC) the patient presented in this report is doing fine six years after
diagnosis with no sign of residual or progressive disease. On the one hand
these rare cases are important in giving newly diagnosed patients hope and
strength to go through a long and often strenuous treatment. On the other hand
cases like these demonstrate the need for finding further valid prognostic
indicators of survival in small-cell lung cancer.
Literature:
1. Albain KS, Crowley JJ, Livingston RB (1991) Long-term survival and toxicity in small
cell lung cancer. Expanded Southwest Oncology Group experience.
2.Hall WA, Djalilian HR, Nussbaum ES, Cho KH (2000) Long-term survival with
metastatic cancer to the brain. Med Oncol 17: 279-286.
3. Lewinski T, Zulawski M (2003) Small cell lung cancer survival: 3 years as a minimum
for predicting a favorable outcome.
4. NCI SEER Statistics Review 1975 – 2004.
5. Pujol JL, Quantin X, Jacot W, Boher JM, Grenier J, Lamy PJ (2003) Neuroendocrine
and serum markers as prognostic determinants of small cell lung cancer.
DEGRO 2009 Bremen
P 96