PROGNOSTIC IMPLICATIONS OF STAGE OF DISEASE AND SITES OF METASTASES IN PATIENTS WITH SMALL CELL-CARCINOMA OF THE LUNG TREATED WITH INTENSIVE COMBINATION CHEMOTHERAPY

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Abstract
The influence of various sites of distant metastases on response and survival was analyzed in 106 consecutive previously untreated patients with small cell carcinoma whose disease was systematically staged. All patients received 6 wk of intensive induction chemotherapy with cyclophosphamide, methotrexate and lomustine; therapy thereafter varied without differential effects on survival. Staging procedures included physical examination, chest roentgenogram, fiberoptic bronchoscopy, bone marrow and liver biopsies, and radionuclide bone, brain and liver scans. On the basis of pretreatment staging, 33 patients (31%) had limited disease. In the remaining 73 patients, sites of extensive disease included bone in 40; with bone as the sole site of metastatic disease in 13; liver in 30, with liver as the only site in 5; soft tissues in 25 (only site in 7); bone marrow in 22 (only site in 2); CNS in 9 (only site in 4); opposite lung in 7 (only site in 4). Although patients with limited disease lived longer than those with extensive disease (median length of survival, 12 vs. 10 mo.), this difference was not significant. This lack of major impact of traditional stage on survival was explained by the similar survival of patients with limited disease and a single site of entensive disease. Prognosis worsened with increasing number of sites of extensive disease (median survival, 11.5 10 and 8 mo. for 1, 2 and 3 or more sites, respectively). Metastases to the liver or CNS significantly shortened survival; involvement of bone, soft tissues or bone marrow had little adverse effect. In patients with small cell carcinoma whose disease is thoroughly staged and who are given aggressive chemotherapy, certain sites or a small number of sites of extensive disease may be treated as successfully as limited disease.