Optimization of small-cell lung cancer chemotherapy with heparin: a comprehensive retrospective study of 239 patients treated in a single specialized center.

PURPOSE: In first-line management for small-cell lung cancer (SCLC), the combination of a platinum salt and etoposide is recommended, with thoracic radiotherapy and prophylactic cranial irradiation in selected patients. Anticoagulants, including heparin, are rarely used. We analyzed the results of these different treatments in a comprehensive population of patients with SCLC. PATIENTS AND METHODS: We retrospectively analyzed clinical and therapeutic characteristics of SCLC patients managed in our center during the period 1990-2002. RESULTS: First-, second- and third-line chemotherapy was received by 98.3, 47.3 and 11.7%, respectively; 55% received curative heparin. The 2-year survival rates were 31 and 7% among patients with localized and metastatic disease, 33 and 15% among patients treated with the PCDE (cisplatin-cyclophosphamide-doxorubicin-etoposide) regimen with and without heparin, and 27 and 12% among patients treated with the PE (cisplatin or carboplatin-etoposide) regimen with and without heparin, respectively. The 2-year survival rate among the 27 patients who received an optimal combination of PCDE, heparin, thoracic radiotherapy and prophylactic cranial irradiation was 44.2%. In multivariate analysis, localized disease, younger age, use of heparin and inclusion in a clinical trial were independently associated with a better outcome. CONCLUSION: Despite the bias inherent in a retrospective, single-center study, these results support chemotherapy optimization for SCLC patients and confirm the value of heparin in this setting.

[Supportive cares on thoracic oncology]. / Soins de support en oncologie thoracique.

Palliative cares become an important element of the management of patients with lung cancer. The objective of this review is to review the literature data's of the impact of palliative cares in oncology, more particularly in thoracic oncology. The analysis concerns the impact of an early access to the palliative cares and the characteristics of these cares in thoracic oncology. The data of the literature are in favour of an early access and structured intervention. Nevertheless, numerous research questions remain, in particular the best moment to implant these palliative cares (at the diagnosis, at the beginning of the chemotherapy…), the assessment of each components of these programs and the economic impact of these initiatives.