Title

Does Sex Influence the Impact that Smoking, Treatment Interruption and Impaired Pulmonary Function Have on Outcomes in Limited Stage Small Cell Lung Cancer Treatment?

Authors

Gregory M. M. Videtic, Cleveland Clinic Foundation, Cleveland, OH
Pauline T. Truong, British Columbia Cancer Agency, Victoria, BC
Robert B. Ash, London Regional Cancer Centre, London, ON
Edward W. Yu, University of Western OntarioFollow
Walter I. Kocha, London Regional Cancer Centre, London, ON
Mark D. Vincent, University of Western OntarioFollow
Anna T. Tomiak, Kingston Regional Cancer Centre, Kingston, ON
A Rashid Dar, University of Western OntarioFollow
Frances Whiston, London Regional Cancer Centre, London, ON
Larry W. Stitt, University of Western OntarioFollow

Document Type

Article

Publication Date

7-2005

Journal

Canadian Respiratory Journal

Volume

12

Issue

5

First Page

245

Last Page

250

Abstract

PURPOSE: To look for survival differences between men and women with limited stage small cell lung cancer (LS-SCLC) by examining stratified variables that impair treatment efficacy.

METHODS: A retrospective review of 215 LS-SCLC patients treated from 1989 to 1999 with concurrent chemotherapy-radiotherapy modelled on the 'early-start' thoracic radiotherapy arm of a National Cancer Institute of Canada randomized trial.

RESULTS: Of 215 LS-SCLC patients, 126 (58.6%) were men and 89 (41.4%) were women. Smoking status during treatment for 186 patients (86.5%) was: 107 (58%) nonsmoking (NS) (76 [71%] male [M]; 31 [29%] female [F]) and 79 (42%) smoking (S) (36 M [46%]; 43 F [54%]) (continuing-to-smoke F versus M, P=0.001). Fifty-six patients (26%) had radiotherapy interruptions (RTI) during chemotherapy-radiotherapy because of toxicity. Radiotherapy breaks were not associated with sex (P=0.95). Survival by sex and smoking status at two years was: F + NS = 38.7%; F + S = 21.6%; M + NS = 22.9%; and M + S = 9.1% (P=0.0046). Survival by sex and RTI status at two years was: F + no RTI = 32.4%; F + RTI = 23.6%; M + no RTI = 23.0%; and M + RTI = 3.8% (P=0.0025). Diffusion capacity for carbon monoxide (DLCO) was recorded for 86 patients (40%) and median survival by sex and DLCO was F = 16.7 months and M = 12.1 months for a DLCO less than 60%; and for a DLCO 60% or more, F = 15.1 months and M = 15.3 months. First relapses were recorded in 132 cases (61%), with chest failure in men (45%) greater than for women (35%) and cranial failure rates similar between sexes (48%). Upon multivariable analysis, continued smoking was the strongest negative factor affecting survival.

CONCLUSIONS: In LS-SCLC, women overall do better than men, with or without a negative variable. The largest quantifiable improvement in survival for women came from smoking cessation, and for men from avoidance of breaks during treatment.