Small Cell Lung Cancer in Good Performance Status: A Mono-Center Tunisian Study

Abstract

Background: Small cell lung cancer (SCLC) accounts for 20% of lung cancers with aggressive presentation. Therapies for SCLC have lagged behind the current standard treatment, the prevailing state-of-the-art from the early 1980s. The aim of this study is to report the epidemiological, clinical profile, therapeutic protocols, and results of SCLC in Tunisian population. Methods: This is a retrospective study, including 60 patients treated for histologically diagnosed with SCLC between 2011 and 2015. Only patients with eastern cooperative oncology group (ECOG) performance status 0 to 2 were considered. Results: Sixty patients were enrolled in this study. The mean age was 61.8 years (range 45 - 77 years). Fifty-five (95%) patients were active smokers. The most frequent symptoms were cough, chest pain, and dyspnea. SCLC was staged as extensive disease in 40 patients (66.7%) and limited disease in 20 cases (33.3%). For diffuse stages, chemotherapy was possible in 34 (85 %) of patients. We observed 2 (5%) complete responses, 9 (22.5%) partial responses, 3 (7.5%) stable diseases, and 9 (22.5%) progressions. Only 11 patients (27.5%) received second line chemotherapy with a median time to progression of 2.2 months. Five patients died, 1 had partial response, and 3 had progressive disease. One patient received third line chemotherapy. For localized stages, 7 (35%) patients received concomitant radiochemotherapy, 5 (25%) primary chemotherapy followed by concomitant radiochemotherapy, and 8 (40%) sequential treatment. Two (10%) patients had complete response, 8 (40%) partial response, 3 (15%) stable disease, 4 (20%) progressive disease, and 1 patient died. Twelve patients relapsed (60%) with a median time to progression of 2 months. Ten patients received relapse chemotherapy. Four patients died from their disease and 4 had a progressive disease. The median survival was 10 months for the overall population, 12.5 months, and 9 months for localized stages and diffuse stages, respectively. Conclusions: In diffuse SCLC and even with ECOG performance status 0 to 2, first line chemotherapy was feasible in only 85% of cases and second line in only 27.5%. In localized disease, upfront therapy and relapse therapy were possible for 100% and 83% of cases, respectively.