Giulio Metro1, Biagio Ricciuti2, Rita Chiari1, Marina Baretti3, Lorenzo Falcinelli4, Diana Giannarelli5, Angelo Sidoni6, Giannis Mountzios7, Lucio Crinò1, Guido Bellezza6, Alberto Rebonato8, Piero Ferolla1, Luca Toschi3. 1. Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy. 2. Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy. Electronic address: biagio.ricciuti@gmail.com. 3. Division of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, MI, Italy. 4. Radiotherapy Unit, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy. 5. Biostatistics & Data Management Core, Regina Elena Cancer Institute, Rome, Italy. 6. Department of Experimental Medicine, Pathological Anatomy and Histology Unit, University of Perugia, Italy. 7. Deparment of Medical Oncology, University of Athens School of Medicine, Athens, Greece. 8. Department of Diagnostic Imaging, University of Perugia, Italy.
Abstract
BACKGROUND: Among patients with advanced high-grade neuroendocrine carcinoma (HGNEC) of the lung, the optimal therapeutic management is much less established for large cell neuroendocrine carcinomas (LCNECs) than for small cell lung cancers (SCLCs). We evaluated the survival outcomes and incidence of brain recurrence of advanced LCNECs, and compared them with those of a population of SCLCs matched by stage. MATERIALS AND METHODS: Forty-eight unresected stage III HGNECs (16 LCNECs and 32 SCLCs) and 113 stage IV HGNECs (37 LCNECs and 76 SCLCs) were eligible for the analysis. The efficacy of platinum-etoposide chemotherapy with or without thoracic radiotherapy (TRT) and/or prophylactic cranial irradiation (PCI) was investigated. RESULTS: Overall response was significantly lower for LCNECs compared with SCLCs for both stage III (43.8% vs 90.6% respectively, P=0.004) and stage IV (43.3% vs 64.5%, respectively, P=0.04). Similarly, an inferior outcome was observed in terms of progression-free survival (PFS), and overall survival (OS) for LCNECs compared with SCLCs, which, however, reached significance only for stage III disease (median: 5.6 vs 8.9 months, P=0.06 and 10.4 vs 17.6 months, P=0.03 for PFS and OS, respectively). In the lack of PCI, LCNECs showed a high cumulative incidence of brain metastases, as 58% and 48% of still living stage III and IV patients, respectively, developed brain metastases at 18 months. CONCLUSION: Patients with advanced LCNECs are at high risk for brain recurrence. Unresected stage III LCNECs treated with platinum-etoposide with or without TRT bear a dismal prognosis, when compared indirectly with SCLC counterparts. Randomized trials should evaluate whether PCI could improve survival of advanced LCNECs.
BACKGROUND: Among patients with advanced high-grade neuroendocrine carcinoma (HGNEC) of the lung, the optimal therapeutic management is much less established for large cell neuroendocrine carcinomas (LCNECs) than for small cell lung cancers (SCLCs). We evaluated the survival outcomes and incidence of brain recurrence of advanced LCNECs, and compared them with those of a population of SCLCs matched by stage. MATERIALS AND METHODS: Forty-eight unresected stage III HGNECs (16 LCNECs and 32 SCLCs) and 113 stage IV HGNECs (37 LCNECs and 76 SCLCs) were eligible for the analysis. The efficacy of platinum-etoposide chemotherapy with or without thoracic radiotherapy (TRT) and/or prophylactic cranial irradiation (PCI) was investigated. RESULTS: Overall response was significantly lower for LCNECs compared with SCLCs for both stage III (43.8% vs 90.6% respectively, P=0.004) and stage IV (43.3% vs 64.5%, respectively, P=0.04). Similarly, an inferior outcome was observed in terms of progression-free survival (PFS), and overall survival (OS) for LCNECs compared with SCLCs, which, however, reached significance only for stage III disease (median: 5.6 vs 8.9 months, P=0.06 and 10.4 vs 17.6 months, P=0.03 for PFS and OS, respectively). In the lack of PCI, LCNECs showed a high cumulative incidence of brain metastases, as 58% and 48% of still living stage III and IV patients, respectively, developed brain metastases at 18 months. CONCLUSION:Patients with advanced LCNECs are at high risk for brain recurrence. Unresected stage III LCNECs treated with platinum-etoposide with or without TRT bear a dismal prognosis, when compared indirectly with SCLC counterparts. Randomized trials should evaluate whether PCI could improve survival of advanced LCNECs.
Keywords:
Chemotherapy; High-grade neuroendocrine carcinoma of the lung; Large cell neuroendocrine carcinoma of the lung; Platinum-etoposide; Prophylactic cranial irradiation; Small cell lung cancer
Authors: Jules L Derks; Robert Jan van Suylen; Erik Thunnissen; Michael A den Bakker; Harry J Groen; Egbert F Smit; Ronald A Damhuis; Esther C van den Broek; Ernst-Jan M Speel; Anne-Marie C Dingemans Journal: Eur Respir J Date: 2017-06-01 Impact factor: 16.671
Authors: Arsela Prelaj; Sara Elena Rebuzzi; Gabriella Del Bene; Julio Rodrigo Giròn Berrìos; Alessandra Emiliani; Lucilla De Filippis; Alessandra Anna Prete; Silvia Pecorari; Gaia Manna; Carla Ferrara; Daniele Rossini; Flavia Longo Journal: ERJ Open Res Date: 2017-03-29