Journal of Thoracic Oncology:
Letters to the Editor
Imperial College and The Academic; Division of Thoracic Oncology; The Royal Brompton Hospital;United Kingdom;email@example.com
Disclosure: The author declares no conflicts of interest.
We thank Dr. Debevec for his insightful comments and the opportunity to clarify a number of points from our work. The survival estimates are derived from Kaplan Meier methods, which represent actuarial survival, the standard method for reporting and as such there should not be any controversy.
In our small series, we are simply stating the observation that the International Union Against Cancer tumor, node, metastasis staging had poor discrimination for survival in the patients that made up our cohort, we are in no way implying that the staging system itself is poor. We acknowledge in our article that this may simply be due to small sample size.
Our article is a cohort study, and we reported excellent survival, unfortunately we do not have a robust explanation to account for this. One limitation was that we have a very wide referral base and as such we are not certain if patients that had been discharged from our care received further adjuvant treatment locally.
Our results question the prevailing thinking that all patients with small cell lung cancer, except those in the earliest stages, should be considered only for chemo-radiotherapy. We hope that more international centers will review and publish their 5-year survival results to provide further information and we are currently proposing a clinical trial that we hope will be able to provide a more robust answer to some of the questions that have been raised.
Eric Lim, MB ChB, MD, MSc, FRCS
On behalf of the co-authors
Imperial College and The Academic Division of Thoracic Oncology
The Royal Brompton Hospital