Sequential or concomitant chemotherapy in limited stage small-cell lung cancer

K Khanfir,Ro Mirimanoff,M Elhfidh,O Matzinger,S Bieri,S Anchisi,A Zouhair,M Ozsahin

doi:10.4414/smw.2011.13205

Abstract

Chemotherapy (CT) combined with radiation therapy (RT) is the standard treatment for limited disease small-cell lung cancer (LDSCLC). Many questions including RT dose, fractionation, and sequence of RT/CT administration remain controversial. In this paper, we retrospectively assessed the outcome of patients with LDSCLC treated with radiation of at least 50 Gy. From December 1997 to January 2006, 69 consecutive patients with LDSCLC were treated at our institutions. Treatment consisted of at least 4 cycles of CT, and 3D conformal thoracic RT. The median age was 61 years (range, 37-78 years). Sequential or concomitant CT/RT was given in 47 (68%) and 22 (32%) of the patients, respectively. The median RT dose was 60 Gy. Prophylactic cranial irradiation (PCI) was administered in 47 (68%) patients. With a median follow-up of 36 months (range, 6-107), 16 patients were alive without disease. The median overall survival time was 24 months, with a 3-year survival rate of 29%. The 3-year disease-free survival (DFS) and loco-regional control (LRC) rates were 23% and 60%, respectively. A better DFS was significantly associated with performance status (PS) 0 (p = 0.004), complete response to treatment (p = 0.03), and PCI group (p = 0.03). A trend towards improved overall survival (OS) was observed for patients who underwent PCI (p = 0.07). Patients treated with sequential CT/RT had a better outcome than those treated with concomitant treatment (3-year DFS rate 27% vs. 13%; p = 0.04). However, PCI was delivered more frequently for the sequential group. No significant dose-response relationship was found in terms of LRC. The multivariate analysis showed that complete response to treatment was the only significant factor for OS. Complete response to treatment was the most important factor for OS. A better DFS was significantly associated with the PCI group. We did not find a significant difference in outcome between patients receiving doses of 60 Gy or more and patients receiving 60 Gy or less.

Highlights

Treatment strategies for small-cell lung cancer (SCLC) have gradually evolved over the past few decades
We retrospectively assessed the outcome of patients with limited disease small-cell lung cancer (LDSCLC) treated with radiation of at least 50 Gy
A better disease-free survival (DFS) was significantly associated with performance status (PS) 0 (p = 0.004), complete response to treatment (p = 0.03), and prophylactic cranial irradiation (PCI) group (p = 0.03)

Summary

Introduction

Treatment strategies for small-cell lung cancer (SCLC) have gradually evolved over the past few decades. The overall outcome of patients has remained poor due to both local and systemic relapses [1]. Chest radiotherapy (RT) in combination with CT has become a generally accepted treatment for limited stage SCLC (LDSCLC), since it has been shown to be superior to CT alone [2,3]. It is clear that chest RT improves both local control and survival [2,3], several important questions including RT dose, RT fractionation, RT volume, timing of CT, and RT/CT sequence of administration remain controversial and unanswered. The local failure rate in the chest remains unacceptably high with moderate RT doses. This study aimed to evaluate the outcome and patterns of failure in patients with LDSCLC treated with radiation of at least 50 Gy in two institutions

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Methods

Discussion

Conclusion