title: Patterns of relapse in extrapulmonary small cell carcinoma: retrospective analysis of outcomes from two cancer centres.
abstract: OBJECTIVE
  We conducted a retrospective review of patients with extrapulmonary small cell carcinomas (EPSCCs) to explore the distribution, treatments, patterns of relapse and outcomes by primary site.
  
  
  METHODS
  We have reviewed the outcomes of one of the largest data sets of consecutive patients with EPSCC identified from two major cancer centres.
  
  
  METHODS
  Consecutive patients with a histopathological diagnosis of EPSCC from the two institutions were retrospectively identified.
  
  
  METHODS
  Outcomes were evaluated including stage at presentation, treatments given, sites of relapse, time to distant relapse, progression-free survival and overall survival (OS).
  
  
  RESULTS
  From a total 159 patients, 114 received first-line chemotherapy, 80.5% being platinum-based. Response rate was 48%. Commonest primary sites were genitourinary and gynaecological. 44% of patients presented with metastatic disease. 55.9% relapsed with liver the commonest site, whereas only 2.5% developed brain metastases. Median OS was 13.4 months for all patients, 7.6 months and 19.5 months for those with metastatic and non-metastatic disease, respectively. Gynaecological and head and neck patients had significantly better OS compared to gastrointestinal patients.
  
  
  CONCLUSIONS
  EPSCCs demonstrate high response rates to chemotherapy and high rates of distant metastases. Primary sites may influence prognosis, and survival is optimal with a radical strategy. Brain metastases are rare and we therefore do not recommend prophylactic cranial irradiation.
authors.affiliation: Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK Department of Medicine, Royal Marsden Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gennatas
authors.affiliation: Department of Medicine, Royal Marsden Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Noble
authors.affiliation: Department of Medicine, Royal Marsden Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Stanway
authors.affiliation: Department of Medicine, Royal Marsden Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gunapala
authors.affiliation: Department of Medicine, Dimbleby Cancer Centre, Kings College London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: Department of Histopathology, Royal Marsden Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wotherspoon
authors.affiliation: Department of Oncology, St George's Hospital, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Benepal
authors.affiliation: Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK Department of Medicine, Royal Marsden Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Popat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018288:Carcinoma, Small Cell / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: carcinoma; extrapulmonary; neuroendocrine; relapse; small cell carcinoma; survival