Commentary: Concomitant chemotherapy and radiation for limited stage small cell lung cancer and benefit of adding additional drug into chemotherapy regimen for advanced non-small cell lung cancer

Abstract

The first meta-analysis addresses the issue of timing of concomitant chemotherapy and radiation for limited stage small cell lung cancer (LS-SCLC). For this disease, the past few decades have not seen a significant breakthrough in the use of chemotherapy, although progress has occurred in the optimization of concurrent chemotherapy and radiation. Since the late 1970s, the integration of radiation into treatment has improved long-term survival. The optimal chemotherapy regimen established is the combination of etoposide and cisplatin, as opposed to anthracycline-based regimens. Improvements in the timing of radiation include concurrent and early initiation, which is superior to a sequential approach or delayed radiation treatment. In addition, intensifying radiation by accelerated fractionation, twice a day delivered in 3 weeks rather than 5–6 weeks starting concurrently with chemotherapy, almost doubles the cure rate. This intense treatment program is the current standard of care recommended by the National Comprehensive Cancer Network. In the event that radiation cannot be initiated right away, starting it at the second cycle of chemotherapy is considered acceptable. This evolution clearly shows a movement toward sooner, shorter, and more dose-dense (accelerated) radiation therapy. In this meta-analysis based on seven randomized controlled trials, De Ruysscher and colleagues have proposed