The pulmonary status of patients with limited-stage small cell lung cancer 15 years after treatment with chemotherapy and chest irradiation

Study objectives: To describe pulmonary symptoms, signs, pulmonary function, and lung imaging studies in patients with limited-stage small cell lung cancer (SCLC) 2 to 15 years after receiving treatment with chemotherapy and chest radiotherapy. Design: Retrospective review of clinical records and radiographic studies of patients treated in three different prospective combined-modality studies. Setting: Federal hospital. Patients: One hundred fifty-six patients with SCLC who were enrolled between 1974 and 1994. Interventions: Patients with limited-stage SCLC treated on prospective therapeutic studies of combined chemotherapy and radiation therapy were identified. Pulmonary symptoms, physical findings, pulmonary function tests, arterial blood gas measurements, and chest imaging studies were assessed at baseline, and at I to 2 years, at 3 to 5 years, and at > 5 years following the initiation of treatment. Measurements and results: Initial symptoms included cough in 84 (55%), dyspnea in 59 (39%), and sputum production in 26 (17%). Twenty-three patients lived beyond 5 years (15%) without evidence of recurrence. Seven of these 5-year survivors were without pulmonary symptoms. Pulmonary function test results showed no significant changes in percent predicted values for FVC, FEV1, and FEV1/FVC ratio over the time periods reviewed. The percent predicted values for the diffusing capacity of the lung for carbon monoxide decreased from 71% before the start of treatment to 56% (p < 0.032) at I to 2 years. Values improved in most patients beyond 5),Cars after starting treatment. Radiologist interpretations of chest imaging studies were available for 17 of 23 patients surviving > 5),cars. Most patients had minimal to no changes in imaging study findings beyond 5 years. Conclusions: Long-term survivors with limited-stage SCLC who were treated with combined chemotherapy and chest radiotherapy have minimal changes in pulmonary symptoms or function from 5 to 15 years after the start of treatment. A concern for late toxicity from combined-modality therapy should not dissuade clinicians from offering therapy with potentially curative result with minimal to no pulmonary dysfunction.