Does sex influence the impact that smoking, treatment interruption and impaired pulmonary function have on outcomes in limited stage small cell lung cancer treatment?
GM Videtic | PT Truong | RB Ash | EW Yu | WI Kocha | MD Vincent | AT Tomiak | AR Dar | F Whiston | LW Stitt
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.
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
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
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.