title: Small steps of improvement in small-cell lung cancer (SCLC) within two decades: a comprehensive analysis of 484 patients.
abstract: BACKGROUND
  It is not clear whether or not the fate of patients suffering from small-cell lung cancer (SCLC) has improved. To better understand the course of disease, we aimed at documenting disease features at initial diagnosis, sequences of therapy modalities and outcome in consecutive patients over two decades. We postulated that SCLC patients might have benefitted from refined diagnosis and treatment options during the last decade.
  
  
  METHODS
  All SCLC cases diagnosed at the Innsbruck University Hospital and associated institutions between 1991 and 2011 have been documented in detail in accordance with a prespecified protocol.
  
  
  RESULTS
  A total of 484 patients diagnosed with SCLC were followed. The most important symptoms at initial diagnosis were cough, dyspnea and tumor pain in 55%, 51% and 44%, respectively. Patients who were operated during early stage of disease (n = 26) had a favorable 5-year, relapse-free survival (74%). A total of 112 patients with locally advanced disease were treated by radiochemotherapy in curative intent (RCT), and achievement of CR offered a chance of long term overall survival (OS), reaching 44% after 10-years. In the palliative setting (median OS in 304 evaluable patients, 9.7 months), a therapeutic progress in the more recent decade could not be observed. Parameters independently associated with favorable OS were: response to therapy and prophylactic brain irradiation in patients with RCT; and response, age < 70 years and absence of LDH elevation in the palliative setting.
  
  
  CONCLUSIONS
  In this comprehensive view on SCLC, the findings on symptomatology, comorbidity, and spectrum of treatments may help to better understand individual courses of the disease. Overall, modern medicine failed to translate into substantial benefit of SCLC patients, except in patients in locally advanced disease receiving multimodal therapy.
authors.affiliation: Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: michael.fiegl@i-med.ac.at.
authors.forename: M
authors.initials: M
authors.lastname: Fiegl
authors.affiliation: Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Pircher
authors.affiliation: Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Waldthaler
authors.affiliation: Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Gamerith
authors.affiliation: Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Kocher
authors.affiliation: Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Pall
authors.affiliation: Department of Radiooncology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Nevinny
authors.affiliation: Department of Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Schmid
authors.affiliation: Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Sterlacci
authors.affiliation: Department of Pneumology, Academic Natters Hospital, Natters, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Jamnig
authors.affiliation: Department of Internal Medicine, Hospital of Zams, Zams, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Zangerl
authors.affiliation: Department of Internal Medicine, Hospital of Kufstein, Kufstein, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Zabernigg
authors.affiliation: Department of Clinical Epidemiology (IET), Innsbruck, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Oberaigner
authors.affiliation: Department of Internal Medicine V, Hemato-Oncology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Hilbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: Chemotherapy; Comorbidity; Radiochemotherapy; SCLC; Surgery; Symptoms