Effect of sequential chemoradiotherapy in patients with limited-disease small-cell lung cancer who were ineligible for concurrent therapy: a retrospective study at two institutions.

Abstract

The standard treatment for limited-disease small-cell lung cancer (LD-SCLC) is a combination of chemotherapy and concurrent thoracic radiotherapy. In selected cases, sequential radiotherapy is preferred because of the need for a large irradiation field, patient age, comorbidities or performance status. Nevertheless, the efficacy of sequential chemoradiotherapy in patients in whom concurrent chemoradiotherapy is contraindicated is not well known. We retrospectively analyzed 286 patients with LD-SCLC at two institutions in Japan between 2000 and 2014. We compared the clinical characteristics and treatment outcomes of patients undergoing sequential radiotherapy with those undergoing concurrent radiotherapy. One hundred and seventy-five patients received concurrent chemoradiotherapy, 33 received sequential chemoradiotherapy and 46 received chemotherapy only. The median patient age was 64 years (range, 18-82 years) for the concurrent group and 71 years (49-82 years) for the sequential group. Conventional radiotherapy was selected more frequently than accelerated hyperfractionated radiotherapy (27 patients [82%] with conventional radiotherapy, and six patients [18%] with hyperfractionated radiotherapy). The major reasons for the selection of sequential radiotherapy were advanced age (12 patients) and a large irradiation field (11 patients). The median overall survival time was 41.1 months for the sequential group and 38.1 months for the concurrent group. The 5-year survival rates were 36.0% for the sequential group and 41.6% for the concurrent group. In clinical situation, since the treatment outcomes for patients with sequential radiotherapy were comparable to those receiving concurrent radiotherapy, sequential chemoradiotherapy can be a choice for the treatment of patients who are not candidates for concurrent chemoradiotherapy.