Stage Small Cell Lung Carcinoma Research Articles

Use of five-day chronomodulated prescription of palbociclib as myelopreservation drug along with Topotecan in recurrent extensive stage small cell lung carcinoma - A perspective article

Myelopreservation is always a good option when prescribing myelotoxic chemotherapy like Topotecan. Bone marrow toxicity is one of the main hindrances in prescribing such chemotherapy. Cyclin-dependent kinase 4/6 inhibitors (CDK4/6 inhibitors) are known to inhibit the Cell cycle in the G1-S phase. Inhibition of hematopoietic stem cells was the reason for CDK4/6 inhibitor – trilaciclib to be prescribed with Topotecan as a myelopreserving agent. Trilaciclib is an intravenous CDK4/6 inhibitor with a short half-life and can be co-prescribed with chemotherapy. Trilaciclib is currently not available in India. We propose the use of palbociclib, an oral CDK4/6 inhibitor, for the same indication. We suggest the use of a short course of palbociclib for five days, along with chemotherapy, as a myelopreserving agent. We also propose to chronomodulate the dose to maximize the effect.

Risk of Esophagitis in Patients with Limited Stage SCLC Treated with QD or BID Chemoradiotherapy Regimens with Contralateral Esophagus Sparing

Recent randomized phase III trials in limited stage (LS) small cell lung carcinoma (SCLC) demonstrate persistent high rates of grade (G) ≥ 3 esophagitis of 16-19% for 45 Gy BID and 66-70 Gy QD radiotherapy (RT). G3 esophagitis dramatically impairs quality of life and is a barrier to treatment intensification. We previously developed a contralateral esophagus sparing technique (CEST) that reduced esophagitis mainly in patients with locally advanced NSCLC treated with chemoRT to 70 Gy/7 weeks. It is not established whether CEST is effective in LS-SCLC patients, especially those receiving BID RT which may limit mucosal esophageal regeneration during treatment. Here, we report our single-institution experience with this approach. We retrospectively analyzed the records of patients with LS-SCLC who received chemoRT between June 2014 and October 2022. Patients were treated with QD or BID schedules at physician discretion though QD has historically been favored at our institution. The esophageal wall contralateral to the tumor was contoured as an avoidance structure. IMRT or VMAT was used to drive steep dose fall-off across the esophagus while maintaining full tumor coverage. Daily cone-beam CT guidance was employed. Toxicity was assessed using CTCAE v5 criteria. Descriptive statistics were used to analyze outcomes. The study was approved by the IRB. We identified 38 consecutive patients with LS-SCLC treated with definitive chemoRT. Median age was 67 years, and 60.5% were female. Twenty-seven were treated with QD RT to a median dose of 63 Gy (range 55.8-70) in 33 fractions (range 31-35). All remaining patients received BID RT 45 Gy in 30 fractions. Median CTV for the QD and BID cohorts was 205 cc and 214 cc, respectively. Almost all patients (n = 37) had tumor located within 1 cm of the esophagus. There were no ≥G3 esophagitis events (95% CI, 0-9.3%). The rate of G2 esophagitis was 21.1% (11.1-36.3%), with no significant difference between QD (26%) and BID (9%) cohorts (p = 0.3). Only two patients required narcotics. For BID patients, CE planning constraints were scaled to reflect the shortened RT course. The median CE maximum dose, V20, and V30 were 44.8 Gy, 7.9 cc, and 6.4 cc, respectively. For the QD cohort, the median CE maximum dose, V45, and V55 were 59.5 Gy, 3.0 cc, and 0.6 cc, respectively. Treatment breaks occurred in nine QD patients due to neutropenia. Median follow-up was 31.0 months. 3-year overall survival was 70.0% (95% CI, 49.8-83.3%). While we are limited by small patient numbers and possible selection bias, our data suggest that CE sparing can be effective in LS-SCLC, with low severe esophagitis risk even for BID RT regimens. CEST is readily adaptable into clinical practice which should facilitate further refinement of empirically derived CE planning constraints.

Thoracic radiotherapy may improve the outcome of extensive stage small cell lung carcinoma patients treated with first-line immunotherapy plus chemotherapy.

Immunotherapy plus etoposide and platinum (EP)-based chemotherapy is the standard of care for patients with extensive stage-small cell lung carcinoma (ES-SCLC). In the era of immunotherapy, the role of thoracic radiotherapy for ES-SCLC remains unclear. We retrospectively included ES-SCLC patients treated with first-line EP-based chemotherapy plus atezolizumab or durvalumab at Taichung Veterans General Hospital to evaluate the prognostic role and safety of thoracic radiotherapy. A total of 22 patients were included. The median age was 64 years and most of them were male and smokers. Sixteen patients (72.7%) received durvalumab, while the other 6 patients (27.3%) underwent atezolizumab treatment. Among these patients, 11 (50.0%) had a history of thoracic radiotherapy. There was no significant difference in baseline characteristics between patients with and without thoracic radiotherapy. In the overall population, the objective response rate to immunotherapy plus chemotherapy was 73.7%. The progression-free survival and overall survival were 6.0 months (95% CI: 4.0-7.9) and 13.8 months (95% CI: 8.0-19.6), respectively. The overall survival was significantly longer in patients with thoracic radiotherapy (not-reached [NR] [95% CI NR-NR] vs. 9.6 months [95% CI 2.5-16.6]), respectively ( P value by log-rank test <0.001). Both multivariate analysis and subgroup analysis specifically comparing patients with consolidative thoracic radiotherapy and patients with clinical benefits to systemic therapy who did not undergo thoracic radiotherapy indicated that thoracic radiotherapy improved survival. The real-world efficacy of EP-based chemotherapy plus atezolizumab or durvalumab was comparable with that of clinical trials. Thoracic radiotherapy may improve the outcome of ES-SCLC.

Systemic therapy for limited stage small cell lung carcinoma.

Systemic treatment in small cell lung carcinoma has been a challenge for oncologists for decades. The high propensity for recurrence is usually due to distant metastasis, which makes systemic treatment an essential component of treatment in small cell lung carcinoma. The regimen of cisplatin and etoposide (established in the mid-1980’s) concurrently with thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) remains the standard of care in limited stage disease. Despite numerous trials, this regimen has not been improved upon. The standard combination regimen of cisplatin and etoposide has been compared to alternative platinum-containing regimens with drugs like epirubicin, irinotecan, paclitaxel, topotecan, pemetrexed, amrubicin and belotecan. Non-platinum containing regimens like ifosfamide and etoposide have also been tested. Attempts to intensify therapy have included the addition of a third drug like paclitaxel, ifosfamide, tirapazamine, tamoxifen, and thalidomide. Maintenance therapy following induction with chemotherapy, vandetanib and interferon-alpha have also been attempted. Molecularly directed targeted therapies and immunotherapeutic agents are areas of active research. In this review, we discuss the various systemic therapy options in limited stage small cell lung carcinoma, from the historical regimens to the modern-day therapy and promising areas of research. We also discuss the role of growth factors, the optimal number of chemotherapy cycles, the use of prognostic and predictive factors, the optimal timing of chemotherapy and the treatment of special populations of patients including older patients, and patients with comorbidities.

EP1.12-08 Programmed Death-Ligand 1 and Human Leukocyte Antigen Class I Expression in Various Neuroendocrine Tumors of the Lung

Pulmonary neuroendocrine tumors (PNETs) encompass a broad spectrum of tumors including typical carcinoid (TC) and atypical carcinoid (AC) tumors, small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC) with important pathological, biological and clinical differences. Recently, FDA grants Atezolizumab regimen for use in combination with carboplatin and etoposide for the frontline treatment of patients with extensive stage SCLC. The aim of this study was to investigate Programmed death-ligand 1(PD-L1) and Human leukocyte antigen (HLA) class I expression patterns in PNETs. PD-L1 and HLA class I expression was evaluated by immunohistochemistry in a total of 37 resected lung neuroendocrine tumors using tissue microarray. Correlations between the expression of HLA class I/PD-L1 and clinicopathologic features and prognostic significance were analyzed. Of the 37 patients enrolled in this study, 32 patients (86.5%) were male and the median age was 66 years (range, 35–81 years), and 28 patients (75.6%) were current or ex-smokers. The pathologic stage (AJCC 8th) in the patients at presentation was IA(including IA1, IA2, IA3) in 11 patients (24.3%), IB in 4 patients (10.8%), IIA in 1 patients (2.7%), IIB in 4 patients (10.8%), IIIA in 10 patients (27.0%), IIIB in 4 patients (10.8%), and IVA in 1 patients (2.7%). Histologically, 6 patients (16.2%) were diagnosed TC, 5 patients (13.5%) with AC, 9 patients (24.3%) with SCLC, and 17 patients (45.9%) with LCNEC. Positive PD-L1 expression in tumor cells was 29.7% (11/37, 1% cut-off), and the numbers (proportions) of positive PD-L1 expression according to histologic subtypes were as follows; TC/AC/SCLC/LCNEC, 2(33.3%)/2(40.0%)/1(11.1%)/6(35.2%). HLA class I expression was reduced in 86.5% (32/37). The numbers (proportions) of reduced HLA class I expression according to histologic subtypes were as follows; TC/AC/SCLC/LCNEC, 5(83.3%)/5(100%)/8(88.9%)/14(82.4%). In survival analysis, (median overall survival (OS); 56 months) there was no significant difference in OS according to PD-L1 and HLA class I expression status. However, two cases with HLA(+)/PD-L1(+) showed more unfavorable survival curves and three cases with HLA(+)/PD-L1(-) showed a tendency of more favorable clinical course. Lung NETs shows frequent HLA class I reduction and variable PD-L1 expression. Although this is a preliminary study including small number of NETs, the finding that NETs with HLA(+)/PD-L1(-) showed favorable clinical course suggests immune microenvironment might be one of the important biomarker for NETs of the lung.

IBS19.02 Novel Radiotherapy Approaches in Small Cell Lung Carcinoma – Has SABR and Radionuclide Therapy Got a Role to Play?

Thoracic radiotherapy has been shown in to increase overall survival when added to systemic therapy in patients with small cell lung carcinoma (SCLC) and M0 stage. The dose, fractionation, treatment time and timing issues have not been fully resolved. A recent study did not show the superiority of 66Gy in 33 daily fractions over 6.5 weeks over twice-daily radiotherapy to a dose of 45 Gy in 30 fractions over 3 weeks twice daily [1]. For stage I non-small cell lung carcinoma (NSCLC), stereotactic ablative body radiotherapy (SABR) has been clearly shown to be superior to conventional fractionation [2]. Given the clear benefit seen in early stage NSCLC, it is postulated that SABR may have a role to play in early stage SCLC. A recent multi-institutional cohort study has reported favourable outcomes in this setting [3]. However, randomised data of equivalence or indeed superiority are lacking. Furthermore, questions remain as the timing and role of systemic therapy and prophylactic cranial irradiation when SABR is used in this setting. In advanced SCLC, many tumors display neuroendocrine clinical and cytological features and many SCLC tumors express somatostatin receptor and this can be imaged using radiolabeled somatostatin analogs such as 68Ga-DOTATATE [4]. Given the uptake by some SCLC tumors of 68Ga-DOTATATE, higher doses of the tracer have been used in an attempt to provide radiolabelled radiotherapy treatment in metastatic disease in what has been described as peptide receptor radionuclide therapy (PRRT) [5]. This molecularly target radiotherapy is a potentially exciting therapeutic approach, but the ideal positioning of such therapy in tumors which are suitable for treatment with PRRT and the safety of PRRT with systemic therapy have yet to be determined. 1. Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol. 2017;18(8):1116–1125. https://doi.org/10.1016/S1470-2045(1730318-2) 2. Ball D, Mai GT, Vinod S, et al. Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small cell lung cancer (TROG 09.02. CHISEL): a phase 3, open-label, randomised controlled trial. The Lancet. 2019; 20: 494-503 3. Verma V, Simone CB, 2nd, Allen PK, et al. Multi-Institutional Experience of Stereotactic Ablative Radiation Therapy for Stage I Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017;97:362-71 4. Sollini M, Farioli D, Froio A, et al. Brief Report on the Use of Radiolabeled Somatostatin Analogs for the Diagnosis and Treatment of Metastatic Small-Cell Lung Cancer Patients. J Thor Oncol 2013;8(8):1095-1101. 5. Lapa C, Hänscheid H, Wild V, et al. Somatostatin receptor expression in small cell lung cancer as a prognostic marker and a target for peptide receptor radionuclide therapy. Oncotarget. 2016 Apr 12;7(15):20033-40. SCLC, SABR, radiotherapy

Abstract #517 Suspected Isolated Pituitary Metastasis Without Other Central Nervous System Metastasis from Extensive Stage Small Cell Lung Carcinoma

Abstract #517 Suspected Isolated Pituitary Metastasis Without Other Central Nervous System Metastasis from Extensive Stage Small Cell Lung Carcinoma

Adjuvant Chemotherapy Following Surgical Resection Improves Survival in Patients With Early Stage Small Cell Lung Cancer.

The purpose of this study was to determine the effects of resection coupled with standard chemotherapy on the survival prognosis of patients with early stage small cell lung carcinoma (SCLC). Patients (n = 110) with mediastinal lymph node-negative SCLC were enrolled in this study. The baseline clinical data of patients with surgery were retrospectively reviewed. Overall survival (OS) and progression-free survival (PFS) were measured by Kaplan–Meier and log-rank test analyses. Ninety-eight patients received mediastinoscopy biopsy, and pulmonary lobectomy or sublobar resection, and 67 patients underwent adjuvant chemotherapy after pulmonary lobectomy. Adjuvant chemotherapy after surgical intervention was associated with longer OS (median OS: 42.14 vs. 33.53 months, p = 0.01) and PFS (median PFS: 25.20 vs. 13.48 months, p = 0.000) compared to resection alone for all patients. Adjuvant chemotherapy was associated with improvement of survival for N1 patients with stage II (median OS: 36.42 vs. 26.68 months, p = 0.021). The median PFS was 19.02 m (16.08, 21.96) and 13.25 m (10.19, 16.30) (p = 0.031), respectively, for patients of N1 stage who received chemotherapy and those who did not. Cox regression analysis demonstrated that age, TNM stage (N stage, not T stage), and chemotherapy were independent risk factors that might affect overall survival in patients with mediastinal lymph node-negative SCLC. These findings suggest that the application of adjuvant chemotherapy following pulmonary lobectomy is associated with improvements of survival prognoses for patients with SCLC. The combination of surgical intervention with conventional therapy should be taken into consideration as a prospective multidisciplinary regimen for early stage SCLC.

Short Commentary: The Role of Thoracic Radiotherapy in Extensive Stage Small Cell Lung Carcinoma - A Concise Review of the Latest Literature

Short Commentary: The Role of Thoracic Radiotherapy in Extensive Stage Small Cell Lung Carcinoma - A Concise Review of the Latest Literature

Abstract 4831: Small cell lung carcinoma (SCLC) cell line screen of standard of care (etoposide/carboplatin) plus a third agent

Abstract The standard-of-care for limited stage and extensive stage SCLC has remained etoposide and a platinum complex for more than 30 years because 60-80% of patients respond; however, SCLC inevitably recurs. Recurrent SCLC has proven to be resistant to many therapeutics administered as second- or third-line treatments; therefore, combining therapies in the first instance may be a critically useful strategy. A high throughput screen was performed where 62 SCLC lines were exposed to etoposide (0.3uM)/carboplatin (3.7 uM) (E/C) with or without simultaneous exposure to a third agent (n = 220). Viability of the cells was measured using CellTiter-Glo after 96 hr exposure to 9 concentrations of each individual compound or combination with E/C. The test concentrations encompassed the clinical Cmax for each third agent, and the concentrations of E/C selected for the screen were systematically determined to produce SCLC kill that would allow observation of additivity/synergy upon addition of a third agent. IC50s were determined from the concentration response data and showed that the predominant effect of adding a third agent to E/C was additive. Less than additive effects occurred more frequently in SCLC lines that were sensitive to etoposide/carboplatin. Antagonism with E/C occurred in combination with taxanes and tubulin fragmenters such as vinorelbine. Effective single agents such as the nuclear kinase inhibitors (aurora kinase inhibitors, KSP/EG5 inhibitors and polo-like kinase inhibitors) were antagonistic in combination with E/C but were effective single agents. Greater than additive SCLC killing occurred with E/C in combination with several classes of agents. The combination of the Chk1 inhibitor rabusertib with E/C resulted in an IC50 that was &amp;gt;1 log lower than that of rabusertib alone in several SCLC lines. The GSK-3β inhibitor LY-2090314 produced greater than additive SCLC killing in combination with E/C. LY-2090314 had little effect on the SCLC lines alone but the simultaneous combination with E/C resulted in multi-log killing in selected SCLC lines. The BET bromodomain inhibitor MK-8628 was highly effective when combined with E/C as was the PARP1 inhibitor talazoparib in a small subset of the SCLC lines. While many agents have been tested in combination with E/C in SCLC and failed to improve patients’ survival, the findings of this study identified third agents that may represent new leads for the treatment of this recalcitrant disease. Distinct patterns of response in select subsets of the 62 SCLC lines tested may allow identification of biomarkers predictive of the responders to certain 3-drug regimens. This project has been funded in whole or in part with federal funds from the National Cancer Institute, NIH, under contract no. HHSN261200800001E. Note: This abstract was not presented at the meeting. Citation Format: Beverly A. Teicher, Michael Selby, Thomas Silvers, Julie Laudeman, Russell Reinhart, Rene Delosh, Chad Ogle, Ralph Parchment, Julia Krushkal, Dmitriy Sonkin, Joel Morris, Mark Kunkel, David Evans. Small cell lung carcinoma (SCLC) cell line screen of standard of care (etoposide/carboplatin) plus a third agent [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4831. doi:10.1158/1538-7445.AM2017-4831

Utilization of Hyperfractionated Radiation in Small-Cell Lung Cancer and Its Impact on Survival

Twice-daily radiation with concurrent chemotherapy is recognized as the standard of care for the treatment of limited stage small-cell lung carcinoma (SCLC), but its utilization in this setting is unclear. The objective of this study was to analyze modern patterns of treatment for limited stage SCLC and the impact on survival utilizing the National Cancer Database. Between 1999 and 2012, there were 25,045 patients diagnosed with nonmetastatic SCLC who met the selection criteria, of whom 22,626 had survival data. Those receiving 45 Gy in 1.5 Gy fractions twice-daily (BID) were compared with those receiving 45 to 72 Gy in 1.8 or 2.0 Gy fractions. Overall survival was analyzed via Kaplan-Meier analysis and compared using the log-rank test. Multivariate Cox regression analysis was used to identify covariates associated with survival. The utilization of BID radiation overall was 11.3%. Treatment at an academic center was associated with a higher likelihood of receiving BID treatment (odds ratio: 2.29, 95% confidence interval [CI]: 1.95-2.69; p < 0.001). Median survival was 22.1, 17.2, 18.3, 19.2, and 19.5 months for patients receiving 45 Gy BID, 45 Gy once-daily, 46 to 59.4 Gy once-daily, 60 to 61.2 Gy once-daily, and 62 to 72 Gy once-daily, respectively (p < 0.001 for all pairwise comparisons to BID). On multivariate analysis, treatment at an academic center (hazard ratio: 0.88, 95% CI: 0.83-0.93; p < 0.001) and receipt of BID radiation (hazard ratio: 0.92, 95% CI: 0.86-0.98; p = 0.008) were associated with improved survival. The adoption of BID radiation remains very limited, but is more commonly utilized in the academic setting. In this hospital-based study, BID fractionation was associated with improved survival over once-daily fractionation, even at doses ≥60 Gy.

Surgery Alone Versus Surgery Plus Radiation Therapy in Patients With Limited Stage Small Cell Lung Carcinoma: A Population-Based Analysis

Surgery Alone Versus Surgery Plus Radiation Therapy in Patients With Limited Stage Small Cell Lung Carcinoma: A Population-Based Analysis

183 Treating extensive stage small cell lung carcinoma in poor performance status patients – is a high 30 day mortality rate justifiable?

183 Treating extensive stage small cell lung carcinoma in poor performance status patients – is a high 30 day mortality rate justifiable?

180 A review of treatment of limited stage small cell lung carcinoma at the Kent Oncology Centre

180 A review of treatment of limited stage small cell lung carcinoma at the Kent Oncology Centre

Effectiveness and Timing of Prophylactic Cranial Irradiation (PCI) in Limited Stage Small Cell Lung Carcinoma (LS-SCLC) Patients: A Single Institution Experience

Effectiveness and Timing of Prophylactic Cranial Irradiation (PCI) in Limited Stage Small Cell Lung Carcinoma (LS-SCLC) Patients: A Single Institution Experience

Can hippocampus be spared in patients with small cell lung carcinoma (SCLC) during cranial radiation therapy (CRT)?

7596 Background: Although CRT is a standard therapy for prevention and treatment of brain metastases (BM) in patients with SCLC, neurocognitive impairment (NI) following therapeutic whole brain radiation treatment (WBRT) or prophylactic cranial irradiation (PCI) is a major problem and can cause impairment in quality of life. A RTOG study is assessing various outcomes by avoiding the hippocampus (AH) during WBRT in different malignancies. The estimated risk of hippocampal avoidance region metastases (HM) in patients with SCLC before &amp; after WBRT/PCI is not known. AH during CRT may delay the onset of NI in such patients. Our study aims to determine risk of HM in patients with SCLC and to assess clinical factors correlate with it. Methods: A patients cohort of SCLC diagnosed and treated at the Saskatoon Cancer Center between 2005 and 2012 were followed. All MRI and/or CT scans were independently reviewed by a neuroradiologist. HM was defined as BM within 5 mm of hippocampus. Binary Logistic regression analysis was done to assess correlation between various clinical variables and HM using SPSS. Results: 162 patients with SCLC were identified, 60 (37%) have developed BM. The preliminary data of 39/60 patients is presented here. All 39 patients received CRT and 17 patients received upfront chemotherapy. Their median age was 63 yrs (range: 41-82) &amp; M:F was 22:17. 30 (77%) had extensive stage SCLC and 30 (77%) had de novo BM before CRT. A total 198 (range: 1-33) BM were identified among these patients with a mean BM of 6.6 per patient. 4 (13.3%) of 30 patients had HM involvement with mean BM of 1.3 per patient. Median follow up was 13.5 months (range: 1-69). Post-CRT 13 (33%) of 39 patients (4 PCI, 9 WBRT) developed central nervous system (CNS) progression. None of 13 patients with CNS failure following CRT developed HM. Overall 4 (10.2%) of 39 patients developed HM. No clinical factors significantly correlated with HM. Conclusions: The preliminary result revealed that overall incidence of HM before and after WBRT/PCI is low. AH in such patients may consider during CRT to avoid NI. The study is ongoing and final analysis will be presented.

Skin Metastasis in a patient with Small-Cell Lung Cancer

A 64-year-old woman presented with abdominal pain and back pain. Physical examinationrevealed a subcutaneous nodule in the anterior abdominal wall. An ultrasoundguidedbiopsy revealed small cell lung carcinoma (SCLC), and additional workuprevealed extensive stage small cell lung carcinoma with involvement of the left lung andthe abdominal viscera. The patient underwent chemotherapy with a good initial response.Lung carcinoma infrequently metastasizes to the skin. However, these lesions,when present, have important prognostic implications since these patients typicallyrespond poorly to chemotherapy and have a mean survival of about five months. Carefulskin evaluation is essential in the evaluation of patients with possible bronchogeniccarcinoma.

Thoracic Radiotherapy for Limited Stage Small Cell Lung Carcinoma

Thoracic Radiotherapy for Limited Stage Small Cell Lung Carcinoma

158 Prophylactic cranial irradiation in lung cancer: a single institution experience

Introduction: Prophylactic cranial irradiation (PCI) is a treatment modality used to prevent the development of brain metastases in small cell lung carcinoma. Randomized phase III studies have demonstrated an overall survival benefit in limited and extensive stage disease. The aim of this study was to analyze the incidence of symptomatic brain metastases, overall survival and progression-free survival after PCI, in a single institution over a five year period. Method: We conducted a retrospective search of all patients who had received PCI between October 2006 and October 2011 at the Whitfield Clinic, the radiation oncology facility linked to our institution. Patient and disease-related characteristics, the subsequent development of brain metastases, progression-free survival, and overall survival data was collected. Results: 24 patients received PCI in a 5 year period in our institution. 58.3% of patients were male and 41.7% were female, with a mean age of 62.5 years (range 31 78) and a standard deviation of 9.96. All patients were smokers. 50% of patients had limited stage small cell lung cancer and 50% had extensive stage small cell lung cancer. No patients with extrapulmonary small cell carcinoma or non-small cell lung cancer received PCI. 8.2% of the patients developed brain metastases post PCI (p = 0.478.) The median PFS for limited stage disease was 13 months (range 3 20) and 10 months (range 5 18) for extensive stage disease. Median OS was 15 months (range 4 29) for limited stage disease and 11 months (range 5 29) for extensive stage disease. Conclusions: PCI is a treatment modality used in limited and extensive stage small cell lung carcinoma. Our study demonstrated a reduced incidence of symptomatic brain metastases and an improvement in median PFS and median OS, in keeping with published phase III data. PCI in non-small cell lung cancer and extrapulmonary small cell carcinoma remains controversial.

Experience with carboplatin and etoposide maintenance chemotherapy in patients with extensive stage small cell lung cancer.

To determine whether maintenance therapy with carboplatin and etoposide improves progression-free and overall survival in patients with extensive stage small cell lung cancer, compared to the standard four to six cycles of cisplatin and etoposide. Forty-two patient records (25 males and 17 females) were retrospectively reviewed in a single community practice. All patients were over the age of 18, with pathologically and radiographically proven extensive stage small cell lung carcinoma (SCLC). The starting doses of chemotherapy were carboplatin, AUC (area under the curve) of 6 IV day 1, and etoposide, 100 mg/m2 IV days 1-3. The regimen was administered every 3 weeks and increased to every 4 to 5 weeks as tolerated or until documented progression occurred. Varying second-line chemotherapies were used. Median overall survival was 17 months from diagnosis, with a progression-free survival of 15 months. Seventy-nine percent of the patients survived more than 10 months. The 1- and 2-year overall survival (OAS) rates were 0.74 (31 patients) and 0.31 (13 patients), respectively. The 1- and 2-year progression free survival (PFS) rates were 0.50 (21 patients) and 0.21 (9 patients), respectively. The improved overall and progression-free survival compared to the current standard in this small single center cohort suggests that maintenance therapy with carboplatin and etoposide to progression may be a prudent area for further investigation in a properly powered randomized, controlled trial.