P1-203: Retrospective analysis of sequential and concurrent chemoradiotherapy of limited small cell lung cancer (SCLC)

Abstract

Patients with limited disease SCLC were treated up till 2001 with sequential chemoradiotherapy (SCT) and from 2001 with concurrent chemoradiotherapy (CCT). The optimal treatment has yet to be defined. This retrospective study analysed the efficacy of both treatments. Between 1991 until December 2000, 69 SCT pts were included, and from 2001 until February 2005 40 pts who underwent CCT. In SCT, the chemotherapy consisted of 5 cycles of cyclophosphamide, doxorubicin and etoposide. In case of complete remission, radiotherapy was given in once-daily fractions of 2.5 Gy, 5 fractions/week, to a total dose of 40 Gy. Prophylactic cranial irradiation (PCI) was given in 15 fractions of 2 Gy, 5 fractions/week. In CCT, radiotherapy was started on day 22 after start chemotherapy. The fraction dose was 1.8 Gy, 5 fractions/week, the total dose was 45 Gy. Chemotherapy consisted of 4 or 5 cycles of cisplatin and etopside. PCI was applied to patients who had achieved a complete response. Primary endpoints are radiological response, median survival time and 3- and 4-year overall survival; secondary endpoints include causes of death, frequency of metastases and toxicity. The Kaplan-Meier method was applied to determine the median survival time and the survival rates. The mean and median tumour volume of SCT pts was 142 and 81cm3, those of CCT pts 117.6 and 40 cm3, resp. The mean overall treatment time of SCT was 182 d, and that of CCT 89 d. The radiological complete response of SCT pts was 95.6%, of pts with CCT 60%. PCI was applied to 95.6% of the SCT pts and to 57.5% of the CCT pts. The SCT median survival time was 24.9±3.0 month; the 3- and 4-year overall survival were 38.8±6.1 and 31.5±6.0%, respectively. The CCT median survival time was 23.8±4.2 month and the 3- and 4-year overall survival 36.7±8.3 and 31.5±8.6 %, respectively. Of the 69 SCT pts, 51 had died of which 38 pts (74.5%) with tumour and 21 of 24 CCT pts (87.5%). Grade3/4 haematological side effects were reported in 47 (68%) SCT pts and in 18 (45%) CCT pts. Symptomatic radiation oesophagitis was observed in 41 (59%) of SCT pts and in 19 (47.5%) of the CCT pts. Brain metastases were diagnosed in 12 (17%) SCT pts and in 13 (32.5%) CCT pts. The mean interval time for SCT pts between restaging after chemotherapy and start of radiotherapy was 52.3 d, the median 47 d, and the range 21-173 d. Although a higher mean and median tumour volume, a better radiological response was obtained for the SCT pts. The median survival time and the 3- and 4-y survival rates were not significantly different. The frequency of brain metastases in CCT pts was twice of that of SCT pts.