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Response rates of SCLC to cisplatin and etoposide are excellent: 80 100% response in limited-stage disease (50 70% complete
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response), and 60 80% response in extensive stage disease (15 40% complete response) However, remissions tend to be short-lived with a median duration of 6 8 months Once the disease has recurred, median survival is 3 4 months Overall 2year survival is 20% in limited-stage disease and 5% in extensive-stage disease Thoracic radiation therapy improves survival in patients with limited SCLC but not those with extensive disease Whole brain radiation therapy decreases the incidence of central nervous system disease but does not affect survival Its effect on symptoms is controversial Occasionally, a patient may have a peripheral nodule resected that turns out to be SCLC Five-year survival following resection of the equivalent of stage I and stage II SCLC is higher than in patients treated with chemotherapy
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Table 39 4 Approximate survival rates following treatment for lung cancer
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Non Small Cell Lung Cancer: Mean 5-Year Survival Following Resection Stage IA (T1N0M0) IB (T2N0M0) IIA (T1N1M0) IIB (T2N1M0, T3N0M0) IIIA IIIB1 IV1 Clinical Staging 60% 38% 34% 23% 9 13% 3 12% 4% Surgical Staging 74% 61% 55% 39% 22%
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Photoresection with the Nd:YAG laser is sometimes performed on central tumors to relieve endobronchial obstruction, improve dyspnea, and control hemoptysis External beam radiation therapy is also used to control dyspnea and hemoptysis, pain from bony metastases, obstruction from superior vena cava syndrome, and symptomatic brain metastases Resection of solitary brain metastases does not affect survival but may improve quality of life when combined with radiation therapy Intraluminal radiation (brachytherapy) is an alternative approach to endobronchial disease Pain syndromes are very common in advanced disease As patients approach the end of life, meticulous efforts at pain control are essential (see 5) Consultation with or referral to a palliative care specialist is recommended in advanced disease to aid in symptom management and to facilitate referrals to hospice programs
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Small Cell Lung Cancer: Survival Following Chemotherapy Stage Limited Extensive
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Mean 2-Year Survival 15 20% < 3%
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Median Survival 14 20 months 8 13 months
Independent of therapy, generally not surgical patients Data from multiple sources Modified and reproduced, with permission, from Reif MS et al Evidence-based medicine in the treatment of non-small cell cancer Clin Chest Med 2000;21:107
Prognosis
The overall 5-year survival rate for lung cancer is 15% Predictors of survival are the type of tumor (SCLC versus NSCLC), the stage of the tumor, and the patient s performance status, including weight loss in the past 6 months These are independent predictors in both early and late stage disease Most data suggest that there is no difference among non small cell carcinomas when adjusted for stage and performance status However, squamous cell carcinoma may have a better prognosis than adenocarcinoma or large cell carcinoma at the same TNM stage (see Table 39 4)
American College of Chest Physicians; Health and Science Policy Committee Diagnosis and management of lung cancer ACCP evidence-based guidelines Chest 2003 Jan;123(1 Suppl):D G, 1S 337S [PMID: 12527560] Bach PB et al Computed tomography screening and lung cancer outcomes JAMA 2007 Mar 7;297(9):953 61 [PMID: 17341709] Black WC et al CT screening for lung cancer: spiraling into confusion JAMA 2007 Mar 7;297(9):995 7 [PMID: 17341714] Hamilton W et al Diagnosis of lung cancer in primary care: a structured review Fam Pract 2004 Dec;21(6):605 11 [PMID: 15520035] Henschke CI et al; International Early Lung Cancer Action Program Investigators Survival of patients with stage I lung cancer detected on CT screening N Engl J Med 2006 Oct 26;355(17):1763 71 [PMID: 17065637]
Jackman DM et al Small-cell lung cancer Lancet 2005 Oct 15 21;366(9494):1385 96 [PMID: 16226617] Mazzone PJ et al Lung cancer: Preoperative pulmonary evaluation of the lung resection candidate Am J Med 2005 Jun; 118(6):578 83 [PMID: 15922686] Spira A et al Multidisciplinary management of lung cancer N Engl J Med 2004 Jan 22;350(4):379 92 [PMID: 14736930] Spiro SG et al One hundred years of lung cancer Am J Respir Crit Care Med 2005 Sep 1;172(5):523 9 [PMID: 15961694] Yang P et al Clinical features of 5,628 primary lung cancer patients: experience at Mayo Clinic from 1997 to 2003 Chest 2005 Jul;128(1):452 62 [PMID: 16002972]
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