Abstract
Consolidation radiotherapy in extended disease small cell lung cancer (ED-SCLC) showed improved 2 year overall survival (OS) in patients who responded to chemotherapy according to the results of CREST trial and many centers included this treatment in local guidelines. We retrospectively reviewed medical records of patients with small cell lung cancer (SCLC) treated at the Institute of Oncology Ljubljana from January 2010 to December 2014. Median follow up was 65 months. We compared median overall survival (mOS) of patients with ED-SCLC treated with chemotherapy (ChT) only and those treated with ChT and consolidation radiotherapy (RT). We also compared mOS of patients treated with different consolidation doses. Out of 703 patients 411 (58.5%) had ED-SCLC and were included in our analysis. Of those 59 patients received only best supportive care (BSC), 66 patients had RT only, 113 had ChT only and 173 patients had combination of ChT and RT. Median OS of patients who had either BSC or RT only was poor, 1.86 and 2.42 months, respectively. Patients who had any form of additional chest irradiation had significantly better mOS than patients with ChT only (9.9m vs 7.6m, p=0.002). Consolidation radiotherapy was delivered to 76 patients. Patients with consolidation RT had significantly longer mOS compared to patients with ChT only, 11.1 months (CI 10.1-12.0) vs 7.6 months (CI 6.9 - 8.5), p<0.001. They also had longer 1-year OS (44% vs 23%) as well as 2-year OS (10% vs 5%). Different fractionation schemes were used for consolidation RT. Patients with 45 Gy (in 18 fractions) had better mOS compared to lower doses 30-36Gy (in 10-12 fractions), 17.2 months vs 10.3 months, p=0.03. Patients with higher dose of consolidation RT had better 1-year OS (68% ) than those with lower dose (30%) and also better 2-year OS (18% vs 5%). Consolidation RT improved mOS in ED-SCLC as compared to ChT only. Higher dose of consolidation RT (45Gy) had greater impact on survival than lower doses (30-36Gy).
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