title: Limited-stage small-cell lung cancer (stages I-III): observations from the National Cancer Data Base.
abstract: The standard treatment of limited-stage small-cell lung cancer (LS-SCLC) has changed over the past 15 years. Standard treatment for LS-SCLC currently involves multiple-agent chemotherapy and early concurrent thoracic radiation therapy. Four patient cohorts (total number of patients, 22,969) diagnosed with LS-SCLC in 1985 (N=2123), 1990 (N=6279), 1995 (N=7815), and 2000 (N=6752) were studied in order to describe demographic and treatment pattern changes as well as 5-year survival rates across cohorts. Women composed 40.2% of patients in the 1985 cohort but represented a significant proportional increase over each successive cohort, representing 50.8% of the 2000 cohort. The proportion of patients aged >or=70 years also significantly increased over time, from 31.6% in 1985 to 44.9% in 2000 (P<0.001). Over these years, the use of chemoradiation as the primary treatment for patients with LS-SCLC increased from 34.6% to 51.9% (from 37% to 60.5% for patients aged <70 years, and from 29.5% to 41.3% for patients aged >or=70 years). During the same time, the use of chemotherapy as the sole treatment decreased from 30.7% in 1985 to 21.7% in 2000. Chemotherapy as the sole treatment was used in 25.9% of the population>or=70 years of age in 2000, compared with 18.3% in patients aged <70 years. The percent of patients for which there was no treatment given did not change significantly between the cohorts (14.3% in 1985 and 13.7% in 2000; P<0.001). The 5-year survival rates and 95% confidence intervals (CIs) for the 1985, 1990, and 1995 cohorts of all ages of patients treated with chemoradiation therapy are as follows: 10.5% (CI, 6.75%-14.25%), 11.88% (CI, 9.63%-14.13%), and 13.3% (CI, 11.2%-15.4%). Between 1985 and 2000 there was a significant increase in the percentage of women diagnosed with LS-SCLC. The use of combined chemotherapy and radiation therapy also increased during this period. This increase in chemoradiation therapy was associated with a decreased use of chemotherapy alone. Despite changes in demographics and treatment during these time intervals, the 5-year survival for patients with LS-SCLC treated with chemoradiation therapy did not increase significantly. These results demonstrate the continued need for the evaluation of new treatments in this group of patients.
authors.affiliation: Department of Radiation Oncology, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045-0510, USA. laurie.gaspar@uchsc.edu
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Gaspar
authors.forename: E Greer
authors.initials: EG
authors.lastname: Gay
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Roy S
authors.initials: RS
authors.lastname: Herbst
authors.forename: James A
authors.initials: JA
authors.lastname: Bonner
mesh_terms: D017677:Age Distribution; D000368:Aged; D018288:Carcinoma, Small Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D018714:Radiotherapy, Adjuvant; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology