Abstract
INTRODUCTION: Small cell lung cancer (SCLC) accounts for 13-15% of all lung malignancies and remains a highly aggressive disease with limited therapeutic progress, particularly in rural settings. Despite advances such as immune checkpoint inhibitors and multimodal therapy, real-world evidence on treatment utilization and survival outcomes in developing regions is scarce. This retrospective cohort study aimed to evaluate survival patterns and multimodal therapy use in SCLC patients from a Chinese countryside hospital. METHODS: A total of 132 patients diagnosed with SCLC at Weifang Yidu Central Hospital between 2014 and 2023 were retrospectively analyzed. Patients were classified as limited-stage (LS) or extensive-stage (ES) using the Veterans Administration Lung Study Group (VALG) system. Clinical data, including demographics, treatment regimens, and outcomes, were collected. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method, and subgroup analyses assessed the effects of platinum sensitivity, prophylactic cranial irradiation (PCI), concurrent chemoradiotherapy (CCRT), and palliative radiotherapy. RESULTS: Of 132 patients (64 LS-SCLC, 68 ES-SCLC), most received first-line platinum-etoposide regimens, with diminishing treatment continuity in later lines due to cumulative toxicities. Median OS was significantly longer in LS-SCLC than ES-SCLC (50.2 vs. 16.8 months, p<0.05). PCI reduced brain metastases (0% vs. 27%) and improved OS (50.2 vs. 36.4 months; HR=0.47), though not statistically significant. CCRT achieved longer OS than sequential chemoradiotherapy (54.9 vs. 50.2 months; HR=0.54). In second-line therapy, platinum-sensitive patients benefited from platinum rechallenge (median OS 17.7 vs. 12.5 months, p<0.05), whereas platinum-resistant patients showed no improvement. Palliative radiotherapy in ES-SCLC prolonged PFS (16.1 vs. 7.8 months) and OS (30.2 vs. 16.1 months) with near-significant trends (HR≈0.5). DISCUSSION: This real-world study confirms that concurrent chemoradiotherapy (CCRT) and prophylactic cranial irradiation (PCI) confer survival advantages in LS-SCLC, while palliative radiotherapy yields potential benefits in ES-SCLC. Platinum sensitivity remains a crucial predictor of second-line treatment efficacy, supporting reintroduction of platinum in sensitive relapses per guideline recommendations. Conversely, irinotecan-lobaplatin combinations provided limited benefit. Findings emphasize the need for personalized treatment sequencing and improved access to standardized multimodal care in rural healthcare settings.