Patterns of Care and Factors Affecting it in Small Cell Lung Cancer – Analysis of 3 Years Data from a Tertiary Care Hospital in India

Objective: In India, 75,000 new cases of lung cancer are diagnosed every year, with approximately 35% of them being locally advanced at presentation. Despite numerous advances in recent years in terms of diagnostic methods, molecular changes, and therapeutic interventions, the outcomes of the small cell lung cancer (SCLC) patients remain poor. There is a dearth in our current understanding of the changing epidemiological trends of small cell lung cancer among Indian patients.

Aim of this study is to evaluate the safety and efficacy of standard chemotherapy or chemo radio therapy in elderly patients with SCLC and their outcome and analysis of prognostic factors.

Methods and Materials: 36 cases of SCLC diagnosed either by histopathology or cytology were accrued for the single Institutional retrospective audit and were analysed. Patients with extensive stage disease are planned for six cycles of platinum doublet based chemotherapy and those with limited stage disease are planned for concomitant or sequential chemo radiation depending on various patient related factors. Patients received 4-6 cycles of chemotherapy (cisplatin 80 mg/M2 Day 1, etoposide 120 mg/m2 Day 1-3), following which based on their initial stage & response after Chemotherapy, Thoracic Radiation and PCI (Prophylactic Cranial Irradiation) were given to the suitable candidates.

Statistical analysis was done by bivariate analysis, cox regression analysis, Chi square test, Kaplan Meier survival analysis using IBM SPSS software v.23.

Results: There was a median diagnostic delay of 3 months, about 60% patients presented with extensive stage disease, among which 25% were brain metastasis & 8.2% were having bone mets. Response rate of patients above or below 60yrs were not statistically significant (66% v/s 69%). Median survival were 14 months & 7months for limited & extensive stage.

Conclusion: Elderly Patients can benefit from the EP (Etoposide, Platin) regimen with or without thoracic RT (Radio therapy). Stage, PS (Performance status), Treatment type were notable prognostic factors of median survival. More Prospective, randomised trials are warranted.