Limited-disease Small-cell Lung Cancer Research Articles

Integration of irinotecan and cisplatin with early concurrent conventional radiotherapy for limited-disease SCLC (LD-SCLC)

This study was conducted using irinotecan and cisplatin (IP) concurrently with thoracic radiation therapy to evaluate the response and toxicity of this protocol in the treatment of patients with limited-disease small cell lung cancer (LD-SCLC). Twenty-seven chemotherapy-naive patients with LD-SCLC received two cycles of weekly irinotecan 60 mg/m(2) and cisplatin 60 mg/m(2) before the initiation of the thoracic radiation therapy. Of the 29 patients with LD-SCLC enrolled in the study, 27 were eligible for evaluation of response and toxicity. The median age was 62 years; 26 patients (90%) were men. Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 5 patients (17%) and 1 in 18 patients (62%). Ten patients (37%) achieved a complete response (CR), 14 patients (52%) achieved a partial response (PR), while 3 patients (11%) had progressive disease (PD); one of the 3 nonresponders achieved a PR after commencing concurrent chemoradiotherapy; therefore, the overall response rate was 93%. The median survival time was 20.2 months and 1- and 2-year survival rates were 69% and 53.2%, respectively. The median progression-free survival (PFS) was 11.8 months, and 1- and 2-year PFS times were 52% and 34.1%, respectively. Neutropenia was the most prevalent hematological toxicity and it was evident as grade 3 in 14 patients (52%). Asthenia was the most prevalent nonhematological toxicity, in 18 patients (67%); esophagitis occurred in 15 patients (56%). No treatment-related deaths (due to sepsis or bleeding) were reported in the study. Irinotecan and cisplatin is considered to be an effective and safe chemotherapeutic regimen when used concurrently with thoracic radiation therapy for the treatment of patients with LD-SCLC.

Chemoradiation therapy in patients (pts) with small cell lung cancer (SCLC) with pericardial effusion but no distant metastasis

7555 Background: Our previous retrospective analysis demonstrated that the survival of the limited-disease (LD) SCLC pts with ipsilateral pleural effusion was intermediate between those of LD pts without ipsilateral pleural effusion and extensive-disease (ED) pts, and that long-term survival was achieved by LD-SCLC pts with ipsilateral pleural effusion who successfully underwent chemoradiotherapy (CRT) (J Thorac Oncol 2008;3:723–7). We retrospectively investigated the clinical course and outcome in pts with SCLC with pericardial effusion but no distant metastasis and examined the overall survival in pts who received chemotherapy and definitive thoracic radiotherapy (TRT). Methods: The medical records of SCLC pts who received treatment at the National Cancer Center Hospital East between July 1992 and December 2007 were reviewed. During this period 767 pts were newly diagnosed as having SCLC. Four-hundred seventeen pts had no distant metastasis. Ninety-six of those 417 pts (23%, 95% confidence interval (CI): 19–27%) had pleural or pericardial effusion or disseminated pleural nodules, and were included in this study. The 96 pts were divided into two groups: group A included pts with pericardial effusion (n=33), and group B included pts who had pleural effusion and/or disseminated pleural nodules, but did not have pericardial effusion (n=63). Sixteen pts had both pleural and pericardial effusion. Results: All but one patient received systemic chemotherapy. A remaining patient with pleural effusion received only best supportive care. In group A, 19 pts received chemoradiotherapy. TRT was conducted concurrently with 3 or 4 cycles of chemotherapy in 12 pts and sequentially in 7 pts. The response rate for first-line chemotherapy was 79%. In group B, 26 pts received chemoradiotherapy. Survival data were shown as below. Conclusions: Long-term survival was seldom achieved by SCLC pts with pericardial effusion but no distant metastasis, even if they underwent chemoradiotherapy. [Table: see text] No significant financial relationships to disclose.

Outcome and treatment in elderly patients with small cell lung cancer: A retrospective study

The number of elderly patients with small cell lung cancer (SCLC) is expected to increase with the growing geriatric population. The aim of this study is to evaluate the safety and efficacy of standard chemotherapy or chemoradiotherapy in elderly patients with SCLC. In this retrospective study, we analyzed the data of 126 patients with SCLC diagnosed between 1996 and 2005 at our hospital, and compared the outcome of younger patients less than 70 years and elderly patients 70 years or older who were treated with etoposide and cisplatin (EP regimen) and cyclophosphamide, adriamycin and vincristine (CAV regimen). Patients with limited disease SCLC received thoracic radiotherapy (RT) following chemotherapy. Overall response rates (complete and partial response) were not significantly different between patients less than 70 years and patients 70 years or older (69% vs 65%, P = 0.591). The median survival time was 13 months for patients less than 70 years compared with 12 months for patients 70 years or older (P = 0.263), with 2- and 5-year survival rates of 37.8% and 8.2% vs 26.2% and 3.6%, respectively. Progression-free survival of patients 70 years or older was similar to that of patients less than 70 years (P = 0.445). Grade 3 and 4 hematological toxicities were more frequent among the elderly group (leukopenia, 48% vs 31%, P = 0.049; neutropenia, 52% vs 32%, P = 0.028; thrombocytopenia, 38% vs 21%, P = 0.047). In spite of having more grade 3 and 4 hematological toxicity, elderly SCLC patients 70 years or older can benefit from the EP regimen and the CAV regimen with or without thoracic RT. Further investigations are needed to focus on ways to decrease toxicity, especially in the elderly.

High Tumor Metabolic Activity as Measured by Fluorodeoxyglucose Positron Emission Tomography Is Associated with Poor Prognosis in Limited and Extensive Stage Small-Cell Lung Cancer

We investigated the prognostic effect of incorporating metabolic assessment by (18)F-fluoro-2-deoxyglucose uptake on positron emission tomography/computed tomography ((18)F-FDG-PET/CT) into a conventional staging system in small-cell lung cancer (SCLC). Seventy-six consecutive patients with pathologically proven SCLC were enrolled. All patients underwent standard treatment after pretreatment (18)F-FDG-PET/CT scanning. The mean values of maximal standardized uptake values (meanSUV(max)) of the malignant lesions upon (18)F-FDG-PET/CT were calculated. The Cox proportional hazards model was used with performance status, lactate dehydrogenase, stage, and meanSUV(max). Patients with high meanSUV(max) were significantly related with the established poor prognostic factors, such as higher lactate dehydrogenase (P = 0.04) and extensive disease (ED; P = 0.01). Furthermore, in multivariate analysis, patients with high meanSUV(max) were associated with poor survival outcomes compared with patients with low meanSUV(max) [adjusted hazard ratio, 3.74; 95% confidence interval (95% CI), 1.67-8.37; P = 0.001, for death and adjusted hazard ratio, 2.25; 95% CI, 1.21-4.17; P = 0.01 for recurrence/progression]. In subgroup analysis, limited disease (LD) with high meanSUV(max) showed significantly shorter overall survival than LD with low meanSUV(max) [high versus low meanSUV(max), 20.1 months (95% CI, 7.9-23.2) versus 35.3 months (95% CI, 27.6-42.9); P = 0.02]. ED with high meanSUV(max) had significantly shorter overall survival than ED with low meanSUV(max) [high versus low meanSUV(max), 9.5 months (95% CI, 4.9-13.9) versus 17.7 months (95% CI, 12.0-20.1); P = 0.007]. These findings were replicated in progression-free survival analysis. In SCLC, tumor metabolic activity as assessed by FDG-PET is a significant prognostic factor and identifies subgroups of patients at higher risk of death in both LD and ED SCLC.

Isolated nodal failure after chemo-radiotherapy in limited disease small cell lung cancer (LD-SCLC)

Background The irradiation volume for treatment of limited disease small cell lung cancer (LD-SCLC), are still controversial. One of the aspects of radiation volume is the use of elective nodal irradiation (ENI), which has never been subjected to randomized study in SCLC patients. Aim To review retrospectively patterns of failure in relation to the radiation field after chemoradiotherapy (CHT-RT) in patients with limited disease small cell lung cancer (LD-SCLC). Material and Methods Between 1997 and 2006, 117 consecutive patients with LD-SCLC received chemotherapy with sequential radiotherapy (70%) and concurrent or alternating CHT-RT (30%). All but one case had predefined elective nodal irradiation (ENI) without inclusion of supraclavicular regions. Prophylactic cranial irradiation (PCI) was administered to 39% of patients. Results The median follow-up for the 20 living patients was 33 months. The overall survival at 2 years was 36% (median survival: 18 months). In-field locoregional progression was observed in 42 patients (36%). Distant metastases occurred in 71 patients (61%). Five patients (4%) developed isolated nodal failure (INF) without local progression in the supraclavicular region. Patients with INF had N3 disease more often than those without INF (60% vs 21%, p = 0.04). There was 5% RTOG grade 3 or higher early radiation toxicity. Conclusions INF failures are rare; however, the need for extension of ENI to supraclavicular areas may be reconsidered in N3 patients.

Concurrent hyperfractionated radiotherapy and chemotherapy for patients with limited small-cell lung cancer. Results from a single institution

Summary Background Concurrent use of chemotherapy and twice-a-day hyperfractionated radiotherapy is an efficacious scheme to control limited disease (LD) small-cell lung cancer (SCLC). Aim Our main objective was to estimate initial results in overall survival for patients with LD-SCLC treated with concomitant chemotherapy and hyperfractionated thoracic radiotherapy in routine practice. Response to treatment and toxicity were also assessed. Material and Methods Forty-nine patients with confirmed LD-SCLC were treated at the Department of Radiotherapy of the Hospital General de Catalonia (Spain) from December 1999 to February 2007. The chemotherapy regimen was cisplatin (80 mg/m 2 ) on day 1 and etoposide (100 mg/m 2 ) on days 1, 2, and 3, every 21 day. The target dose to the tumor volume was 45 Gy. Prophylactic cranial irradiation (PCI), consisting of 30 Gy delivered in 15 fractions, was prescribed for all patients with a response rate >75% (23 of 30 patients). Results Median follow-up was 12 months (range, 6–58 months) and median overall survival was 28.9 months. Two-year and 4-year survival rates were 56.4% and 30.1%, respectively. At 2 years, specific survival, local control, and systemic control were 64.2%, 88.8%, and 46.8%, respectively. Myelotoxicity and oesophagitis were the most severe toxicities. Conclusions The combined schedule – hyperfractionated irradiation plus concurrent chemotherapy – can be applied in routine practice in the context of early radiotherapy, which is considered standard treatment, with acceptable toxicity and similar results to those described in the literature.

Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study

Background: Patients with stage III non-small-cell lung cancer (NSCLC) and limited disease small-cell lung cancer are excluded from concurrent chemoradiation mostly on the basis of comorbidity and age. The purpose of this prospective study was to get insight in what proportion of patients with locally advanced lung cancer would be suitable for concurrent chemoradiation.Patients and methods: From 2002 to 2005, all patients with a pathological diagnosis of lung cancer and with locally advanced disease in the Maastricht Cancer Registry, the Netherlands, comorbidity were prospectively assessed. Patients were regarded as noneligible for concurrent chemoradiation if they had one or more important comorbidity or were 75 years or older.Results: In all, 711 patients were included, 577 with NSCLC and 134 with SCLC. Overall, 166 patients (23.3%) were 75 years or older. Of the 526 patients <75 years, comorbidities were as follows: 278 (52.9%) 0, 188 (35.7%) 1, and 56 (11.4%) 2 or more. In all, 408/686 (59%) of the whole patient group were considered as ineligible for concurrent chemoradiation.Conclusions: More than half of patients with stage III lung cancer were theoretically not eligible for concurrent chemoradiation. Less toxic alternatives are needed for these patients.

Is there a place for low-dose chest and prophylactic brain irradiation in limited-disease small cell lung cancer

The aim of the study is to evaluate the outcome of low-dose bifractionated up-front radiotherapy (RT) followed by chemotherapy (CHT) in limited-disease small cell lung cancer (LD-SCLC). From December 1999 to February 2002, 20 LD-SCLC consecutive patients were treated by initial involved-field thoracic irradiation of 2 Gy twice daily to a total dose of 20 Gy, and concomitant prophylactic cranial irradiation (PCI) of 1.8 Gy twice daily to a total dose of 18 Gy followed 3 days later by 4-6 cycles of CHT with cisplatin and etoposide. Median follow-up was 66 months (52-77). There were no Grade 3-4 esophagitis or pneumonitis. Response rate was 90%, 45% of the patients showing a complete and 45% a partial response. Median time to first event was 13 months. Forty percent showed local infield recurrence, while 55% presented distant metastasis, 4 of them in the brain. Median survival time was 28 months. The Kaplan-Meier 1-, 3-, and 5-years survival rates were 95%, 35%, and 21%, respectively. Salvage RT was applied for local recurrence in 7 patients and for distant metastasis in 7 patients. The rate of brain recurrence with up-front low-dose PCI is favorable and should be further evaluated. Although the response and survival rates are promising, the high number of local recurrences indicates that the irradiation dose is insufficient for patients whose disease can be encompassed within a radical radiation portal.

The Role of Surgery in the Treatment of Limited Disease Small Cell Lung Cancer: Time to Reevaluate

Chemo-radiation is considered the standard procedure for the management of limited disease small-cell lung cancer (SCLC). Controversy remains as to when surgery should be considered. We sought to determine the survival after complete resection of SCLC and the prognostic impact of clinical and pathologic stage. A retrospective review was undertaken of patients who underwent surgery between 1980 and 2006. Patients were staged according to the 6th edition of the Tumor, Node, Metastasis classification of lung cancer, actuarial survival estimated with Kaplan Meier methods and comparisons were undertaken using Cox regression. We identified 59 patients who underwent complete resection with nodal dissection for SCLC. The mean age (SD) was 62 (11) years and 41 (69%) were men. Clinical staging information was available in 53, listed by stage with IA (n = 9), IB (n = 21), IIA (n = 0), IIB (n = 13), IIIA (n = 9), IIIB (n = 1). The median time to follow-up (1st to 3rd quartile) was 2.8 (0.79-8.65) years with an overall survival (95% confidence interval) at 1 and 5 years of 76% (65, 88), 52% (40, 68). There were no clear differences in the survival of patients in clinical T categories (p = 0.366) with good overall results in patients across the spectrum of nodal disease from N0 to N2 (p = 0.498). This study shows excellent survival for stage I to III patients who underwent lung resection with nodal dissection for SCLC and supports the need to reevaluate surgery as primary treatment and use of clinical Tumor, Node, Metastasis criteria in the selection of patients with very limited disease for surgery.

Radiotherapy Quality Assurance Review in the Multi-center Randomized Trial for Limited-disease Small Cell Lung Cancer: The Japan Clinical Oncology Group (JCOG) Trial 0202

JCOG introduced radiotherapy (XRT) quality assurance (QA) review in 2002 to improve the quality of clinical trials. This trial was the first one that required on-going XRT QA review in JCOG. The purpose of this study was to analyze the XRT QA score in JCOG 0202. JCOG 0202 was a multi-center phase III trial comparing two types of consolidation chemotherapy after concurrent chemoradiotherapy for limited-disease small cell lung cancer. XRT requirements included a total dose of 45 Gy in 30 fx (BID) without heterogeneity correction; elective nodal irradiation (ENI) of 30 Gy; and at least 1 cm margin around the gross tumor volume (GTV). Dose constraints were defined in regards to the dose to the spinal cord and the lung. Other requirements were overall treatment time and interfraction interval. XRT parameters were screened for compliance during patient accrual and given final compliance score after the completion of accrual. The QA score was given as per protocol (PP), deviation acceptable (DA), violation unacceptable (VU), and incomplete/not evaluable (I/NE) by both an independent radiation oncologist (N.S.) and the radiation oncology principal investigator (S.I.). A total of 283 cases were accrued. Of these, 204 were fully evaluable excluding 79 I/NE cases (ineligible, 5; XRT incomplete, 12; incomplete data submission, 62). Partially evaluable cases were included for evaluation in each item. There were 18 VU in GTV coverage (8% of 238 evaluated); 4 VU and 23 DA in ENI (2% and 9% of 243 evaluated, respectively). No VU was found in overall treatment time, interfraction interval and dose calculation, while some VU were observed in organs at risk (1 VU in the lung and 5 VU in the spinal cord). In total, overall XRT compliance (PP + DA) was 92% (187 of 204 fully evaluable). Comparison between the former and the latter half of the accrued cases revealed that the number of VU and DA had been decreased: VU/GTV, 13 to 5; VU/ENI, 3 to 1; DA/ENI, 20 to 3. The XRT QA score of JCOG 0202 seemed to be acceptable for providing scientifically reliable results. QA program will continue to be an integral part of multi-center clinical trials involving XRT. Introduction of dry-run procedure and intensive feedback to participating institutions will be considered for further improvement in JCOG trials.

Symptom and quality of life results of an international randomised phase III study of adjuvant vaccination with Bec2/BCG in responding patients with limited disease small-cell lung cancer

Aims This study reports the symptom and HRQOL results in which standard treatment was compared to standard therapy plus Bec2, an anti-idiotypic antibody that mimics GD3, a ganglioside antigen. Methods Five hundred and fifteen LD SCLC patients were randomised to receive five vaccinations of Bec2 (2.5 mg)/BCG vaccine arm (VA) or an observational arm (OA) administered over a 10-week period. Survival was the primary end-point; HRQOL was a secondary end-point, assessed using the EORTC QLQ-C30/LC 13. Results There was no improvement in survival or progression-free survival in the vaccination arm. At baseline patients in both arms demonstrated significantly impaired scores on the global QOL scale, when compared to a normative population. However, HRQOL and symptom scores between the two treatment arms were not statistically different at any time point. Conclusion We found no benefits to patient HRQOL by additional vaccination with Bec2/BCG to LD SCLC for patients who have been undergoing standard therapy.

Randomized phase 2 study of subcutaneous amifostine versus epoetin‐α given 3 times weekly during concurrent chemotherapy and hyperfractionated radiotherapy for limited‐disease small cell lung cancer

The purpose of the current study was to investigate the role of amifostine and epoetin-alpha in reducing severe toxicities during concurrent chemo-hyperfractionated radiotherapy (CCRT) for limited disease small cell lung cancer (LD-SCLC). Seventy-six patients with LD-SCLC were enrolled. The treatment schedule was consisted of two 28-day cycles of cisplatin at a dose of 30 mg/m2 (Days 1 and 8) and irinotecan at a dose of 60 mg/m2 (Days 1, 8, and 15) followed by two 21-day cycles of cisplatin at a dose of 60 mg/m2 (Day 1) and etoposide at a dose of 100 mg/m2 (Days 1-3) with concurrent twice-daily thoracic radiotherapy for a total of 45 grays. Patients were randomly assigned at registration to either amifostine at a dose of 500 mg or epoetin-alpha at a dose of 10,000 IU subcutaneously 3 times weekly (n = 36 patients and 40 patients, respectively). Fifteen of 36 patients assigned to the amifostine arm did not receive amifostine because of a lack of supply. Amifostine treatment was associated with higher febrile neutropenia (P = .003) and grade 2 or 3 nausea (according to the National Cancer Institute Common Toxicity Criteria [version 3.0]) (P = .03). It also demonstrated a trend toward higher grade 4 leukopenia (P = .05). Grade 3 esophagitis was reported in 30% of patients treated with amifostine and 9% of patients treated with epoetin-alpha (P = .059). Epoetin-alpha treatment was associated with less grade 2 or 3 anemia (P = .031) and lower decreases in hemoglobin level during CCRT (P = .016). The median survival times for both treatment arms were comparable (22.6 months in the amifostine arm vs 25.6 months in the epoetin-alpha arm; P = .447). Although amifostine administered 3 times weekly during CCRT did not significantly reduce severe toxicities, epoetin-alpha was effective in preventing severe anemia during CCRT in patients with LD-SCLC. Other radioprotective strategies to minimize severe toxicities should be investigated.

Long-term survival after sequential chemoradiation for limited disease small cell carcinoma of the bladder

To evaluate response, time to progression and survival of patients with limited disease (LD) small cell carcinoma of the bladder (SCCB) treated with sequential chemoradiation in analogy to LD small cell lung cancer (SCLC). Of 42 patients with SCCB treated at our institution between 1993 and 2007, 17 with LD SCCB treated with chemoradiation were identified and retrospectively analysed. LD was defined as any pT, cN0-1, cM0. SCCB was defined according to WHO criteria. All patients had platinum-based chemotherapy after transurethral resection (TUR) prior to local radiotherapy with 56-70 Gy. Sixteen patients were male, 1 female. Median age was 62 years. Median overall survival is 32.5 months. All had a clinical local response (15 CR, 2 PR). Systemic progression occurred in 8 (47%) with a median time to progression of 6 months (range 1-16 months), 8 died with a median survival of 17.5 months. Currently, 7 are free of disease (FOD) including 2 at 80 and 87 months. Four (23.5%) had a local recurrence as late as 43 and 50 months; 3 required a salvage cystectomy. Clinical results of sequential chemoradiation for LD SCCB are comparable to contemporary series of LD SCCB treated with cystectomy and upfront or adjuvant chemotherapy. Long-term survival of more than 5 years after chemoradiation can be achieved. The risk of local recurrence is lower than reported, but late recurrences occur. These data suggest that bladder sparing with systemic chemotherapy and local control by radiotherapy should be further investigated in this aggressive disease.

Clinical Outcome of Chemoradiation Therapy in Patients with Limited-Disease Small Cell Lung Cancer with Ipsilateral Pleural Effusion

The indications for definitive thoracic radiotherapy (TRT) in limited-disease small cell lung cancer (LD-SCLC) and ipsilateral pleural effusion have not been thoroughly investigated. We retrospectively investigated the clinical outcome of LD-SCLC patients with ipsilateral pleural effusion. The medical records of SCLC patients who received treatment at the National Cancer Center Hospital East between July 1992 and December 2006 were reviewed. Sixty-three of the 373 LD-SCLC patients (17%) had ipsilateral pleural effusion. Of these, 62 patients received chemotherapy as an initial treatment, and were included in this study. Since about 1998, definitive TRT was routinely performed if the patient's pleural effusion disappeared after induction chemotherapy. The 62 patients were divided into three subgroups: group A included patients who received chemotherapy and TRT (n = 26), group B included patients who did not receive TRT in spite of the disappearance of pleural effusion after first-line chemotherapy (n = 8), and group C included patients who did not receive TRT and whose pleural effusion persisted after first-line chemotherapy (n = 28). The response rate for first-line chemotherapy was 74%. Ipsilateral pleural effusion disappeared after first-line chemotherapy in 34 patients (55%). The median overall survival time was 11.8 months, and the 2 and 3-year survival rates were 21 and 10%, respectively. In groups A, B, and C, the median survival times were 19.2, 10.5, and 9.2 months, respectively, and the 2-year survival rates were 38, 25, and 7%, respectively. Long-term survival was achieved by LD-SCLC patients with ipsilateral pleural effusion who successfully underwent chemoradiotherapy.

Excision Repair Cross Complementing-1 and Topoisomerase IIα Gene Expression in Small-Cell Lung Cancer Patients Treated with Platinum and Etoposide: A Retrospective Study

Aim of the study was to quantify ERCC1, RRM1, and TopoIIalpha mRNA expression profile as predictive factors for response and survival in SCLC patients treated with platinum/etoposide. Total RNA was extracted from microdissected sections of 103 formalin-fixed, paraffin embedded biopsies. Relative quantification was performed by real-time polymerase chain reaction (PCR) using intron-spanning probes. Eighty-five samples (83%) were successfully amplified. Median overall survival (OS) was 9.9 months; 45 patients had limited disease (LD) (OS = 13.1) and 40 had extensive disease (ED) (OS = 7.1). Fifty-six (65%) patients had an objective response to treatment. A gene expression was detectable in all samples and a correlation between ERCC1 and RRM1 (Rs = 0.34, p = 0.0011) was found. According to response to treatment, it was found that lower TopoIIalpha expression was associated to a better response in LD patients (p = 0.025) and, more interestingly, those who had a complete response had lower TopoIIalpha than both partial and nonresponsive patients (p = 0.015). At univariate analysis LD patients with low ERCC1 had significantly longer survival (median survival 14.9 versus 9.9, p = 0.012), whereas RRM1 and TopoIIalpha levels showed no influence on outcome. At the multivariate analysis, ERCC1 was confirmed to be an independent prognostic factor for survival in LD patients. No significant role was found for ERCC1, RRM1 and TopoIIalpha in ED patients. ERCC1 and TopoIIalpha are candidate markers in predicting clinical outcome and response to treatment in LD SCLC patients and are worth of further investigation in a prospective study.

Clinical outcome of chemoradiotherapy in patients (pts) with limited-disease small-cell lung cancer (LD-SCLC) with ipsilateral pleural effusion

7524 Background: The current standard care for LD-SCLC is a combination of chemotherapy and thoracic radiotherapy (TRT). However, the indications for definitive TRT in LD-SCLC and ipsilateral pleural effusion have not been thoroughly investigated. We retrospectively investigated the clinical course and outcome of LD-SCLC pts with ipsilateral pleural effusion. Methods: The medical records of SCLC pts who received treatment at the National Cancer Center Hospital East between July 1992 and December 2005 were reviewed. Fifty-six of the 338 LD-SCLC pts (17%, 95% CI: 13–21%) had ipsilateral pleural effusion and were included in this study. Since about 1998, definitive TRT was routinely performed if the patient's pleural effusion disappeared after induction chemotherapy. The 56 pts were divided into three subgroups: group A included pts who received chemotherapy and TRT (n=23), group B included pts who did not receive TRT in spite of the disappearance of pleural effusion after first-line chemotherapy (n=8), and group C included pts who did not receive TRT and whose pleural effusion persisted after first-line chemotherapy (n=25). Results: All the pts received platinum-based chemotherapy. The response rate was 71%. Ipsilateral pleural effusion disappeared after first-line chemotherapy in 31 pts (55%). The median overall survival time was 12.9 months (95% CI: 10.2–16.9), and the three and five-year survival rates were 14% and 10%, respectively. Four pts have survived for over five years. In groups A, B, and C, the median survival times were 19.2, 14.7, and 9.2 months, respectively, and the three-year survival rates were 22%, 13%, and 8%, respectively. Disease progression was confirmed in 18 of the 23 pts in group A. At the time of disease progression, ipsilateral pleural effusion recurred in 8 of the 18 pts. Conclusions: Long-term survival was achieved by LD-SCLC pts with ipsilateral pleural effusion who successfully underwent chemoradiotherapy. No significant financial relationships to disclose.

18FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: A planning study

Background and purpose To investigate the influence of selective irradiation of 18FDG-PET positive mediastinal nodes on radiation fields and normal tissue exposure in limited disease small cell lung cancer (LD-SCLC). Material and methods Twenty-one patients with LD-SCLC, of whom both CT and PET images were available, were studied. For each patient, two three-dimensional conformal treatment plans were made with selective irradiation of involved lymph nodes, based on CT and on PET, respectively. Changes in treatment plans as well as dosimetric factors associated with lung and esophageal toxicity were analyzed and compared. Results FDG-PET information changed the treatment field in 5 patients (24%). In 3 patients, this was due to a decrease and in 2 patients to an increase in the number of involved nodal areas. However, there were no significant differences in gross tumor volume (GTV), lung, and esophageal parameters between CT- and PET-based plans. Conclusions Incorporating FDG-PET information in radiotherapy planning for patients with LD-SCLC changed the treatment plan in 24% of patients compared to CT. Both increases and decreases of the GTV were observed, theoretically leading to the avoidance of geographical miss or a decrease of radiation exposure of normal tissues, respectively. Based on these findings, a phase II trial, evaluating PET-scan based selective nodal irradiation, is ongoing in our department.

An Unexpected Abdominal 18F-Fluorodeoxyglucose (FDG) Uptake on Positron Emission Tomography (PET) in a Patient with Limited Stage Small Cell Lung Cancer

We report the case of an unexpected 18F-fluorodeoxyglucose-avid lesion in the right lower abdomen in a patient with otherwise "very limited" (T1N0) small cell lung cancer (SCLC). Additional imaging and endoscopic studies showed no abnormality. The patient was treated for presumed very limited disease SCLC, with resection, adjuvant chemotherapy, and prophylactic brain irradiation. Follow-up fusion positron emission tomography-computed tomography revealed an unusual SCLC complication.

Irinotecan and cisplatin with concurrent thoracic radiotherapy in a once-every-three-weeks schedule in patients with limited-disease small-cell lung cancer: A phase I study

Irinotecan and cisplatin with concurrent radiotherapy is a powerful treatment combination for patients with limited-disease small-cell lung cancer (LD-SCLC). The objective was to determine the dose-limiting toxicity (DLT) and maximum-tolerated dose (MTD) of irinotecan and cisplatin with concurrent thoracic radiotherapy (TRT) as a once-every-three-weeks schedule. Patients with LD-SCLC received a fixed-dose of irinotecan (340 mg) and cisplatin (135mg) at day 1 in cycles 1 and 4. During cycles 2 and 3, irinotecan and cisplatin were given in a dose-escalation schedule with concurrent TRT (once daily, total dose 45Gray). No DLT was observed at first two levels (irinotecan 100mg or 120 mg and cisplatin 100mg at day 1 of cycles 2 and 3). In the first five patients, four episodes of grade III diarrhoea/dehydration were observed at cycles 1 and 4. Therefore, from the sixth patient on, fixed-dose irinotecan at cycles 1 and 4 was reduced to 250 mg. At the subsequent level of irinotecan 140 mg and cisplatin 100mg in cycles 2 and 3, two DLTs (severe oesophagitis and late vertebral radiation toxicity) were observed in one patient. Irinotecan 140 mg and cisplatin 100mg with concurrent TRT was considered the MTD. Irinotecan and cisplatin in a once-every-three-weeks schedule is not recommended due to severe toxicity. Irinotecan may be more suited for intermittent weekly administration.

Phase II Study of Etoposide and Cisplatin With Concurrent Twice-Daily Thoracic Radiotherapy Followed by Irinotecan and Cisplatin in Patients With Limited-Disease Small-Cell Lung Cancer: West Japan Thoracic Oncology Group 9902

Phase II Study of Etoposide and Cisplatin With Concurrent Twice-Daily Thoracic Radiotherapy Followed by Irinotecan and Cisplatin in Patients With Limited-Disease Small-Cell Lung Cancer: West Japan Thoracic Oncology Group 9902