P1-208: Sequential or concomitant chemo- and 3D conformal radiotherapy in limited stage small cell lung cancer

Abstract

Chemotherapy (CT) combined to radiation therapy (RT) is the standard treatment in limited disease small cell lung cancer (LDSCLC). Many questions including RT dose, volume, and RT/CT sequence of administration remain controversial. We assess the outcome of patients with LDSCLC. From September 1998 to 2006, 69 patients with LDSCLC were treated at our institutions. Treatment consisted of CT and 3D conformal thoracic irradiation in all patients. Median age was 61 years (range: 37-78). Sequential or concomitant CT/RT was given in 47 (68%) and 22 (32%) of the patients, respectively. Chemotherapy consisted of either cisplatin and etoposide (PE) in 74% of the patients, or ifosfamid, cisplatin and etoposide (ICE) in 26%. Clinical target volume (CTV) included gross tumor volume and enlarged/involved lymph nodes. In 23% of the patients, positron emission tomography was used in the CTV delineation. The median RT dose was 60 Gy. Prophylactic cranial irradiation was given in 47 (68%) patients in complete remission. All patients have completed full treatment. With a median follow-up of 36 months (range: 6-107), 16 patients are alive without disease. Median overall survival time was 24 months, with survival rates of 29% at 3 years. The 3-year disease-free survival (DFS) and locoregional control rates were 23% and 60%, respectively. No significant dose-response relationship was found in terms of locoregional control or survival. However, patients treated with full-dose sequential CT/RT had better outcome than those treated with concomitant treatment (3-year DFS: 27% vs. 13%; p = 0.04; Fig.1). ICE chemotherapy resulted with better outcome (3-year overall survival: 41% vs. 25%; p = 0.04; Fig.2). No major (CTV v3.0 grade 3 or 4) treatment-related morbidity was observed. Sequential administration of ICE chemotherapy followed by 60-Gy 3D conformal RT seems to be better than concomitant PE chemotherapy and RT.