Abstract
Background: Small-cell lung cancer is highly chemo- and radiosensitive tumor. We evaluated two different radiotherapy doses applied sequentially with chemotherapy in relation to time to progression, progression free survival, and overall survival in patients with limited disease of small cell lung cancer. Methods: From 1998 to 2003, 81 patients were treated for small-cell lung carcinoma. Median age was 57 years (range, 36-77 years) and female: male ratio was 1:4. Patients were initially treated with four cycles of chemotherapy during three weeks (cisplatin 80mg/m2 IV, day 1 and etoposide 100 mg/m2 IV, days 1 - 3). One month later, patients received up to 44 Gy, 2 Gy per day, 5 days per week (group I, 41 patients) or above 44 Gy, standard fractionation (group II, 40 patients), to mediastinum and tumor. Range of higher radiotherapy doses was 54 Gy to 64 Gy, standard fractionation. We evaluated if different radiotherapy doses had any influence on time to progression, progression free survival, and overall survival. Results: The median follow up time was 23 months (range, 12-72 months) for both groups of patients (81). The median time to progression in group I of patients (41) was 13 months (range, 11-29 months) while median time to progression in group II of patients (40) was 20 months (min=9, max=60). There was no statistically significant difference in relapse rate between two groups of patients (p>0.05, Fisher test). However, there was difference but not statistically significant in one-year progression free survival (p=0.05, chi square test) between groups, while there was statistically significant difference in two-year progression free survival favoring higher doses of radiotherapy (p<0.05, chi-square test). The median overall survival was 18 months (range, 12-35 months) for group I of patients and 28 months (range, 15-72 months) for group II of patients. There was no statistically significant advantage between two groups of patients for one-year overall survival (p>0.05, chi-square test). However, there was statistically significant difference in overall survival favoring higher radiotherapy doses for two-year overall survival (p<0.05, chi-square test). Conclusion: We found that higher radiotherapy doses had an impact on long-term time to progression, progression free survival, and overall survival (2 years) of patients.
Highlights
Govindan et al reported on the incidence of small-lung cell carcinoma (SCLC) using the Surveillance, Epidemiology, and End Results (SEER) database over the past three decades
We found that higher radiotherapy doses had an impact on long-term time to progression, progression free survival, and overall survival (2 years) of patients
Many questions remain about the optimal way to deliver chemoradiotherapy
Summary
Govindan et al reported on the incidence of small-lung cell carcinoma (SCLC) using the Surveillance, Epidemiology, and End Results (SEER) database over the past three decades. The use of thoracic radiation has become standard in the combined modality treatment approach to limited-stage small-cell lung cancer. Modest total doses of radiation, ranging from 45 to 50 Gy, have been employed because of the observed responsiveness of small cell lung cancer to radiotherapy. Current available data would support an improved survival when the thoracic radiation is delivered early in the course of treatment for patients with limited stage small cell lung cancer [10,11,12,13]. Phase I trials have been performed suggesting the maximum tolerated dose for once-daily radiotherapy to be in the range of 70 Gy [15]. In a phase I trial of 47 patients receiving dose-escalated thoracic radiation, the median survival was an encouraging 24 months [16]. In a subsequent phase II experience www.onk.ns.ac.rs/Archive Vol 18, No 1-2, July 2010
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