Concurrent or Sequential Chemoradiotherapy after 3-4 Cycles Induction Chemotherapy for LS-SCLC with Bulky Tumor

Abstract

The current study was to compare the efficacy and safety between concurrent and sequential chemoradiotherapy after 3-4 cycles of induction chemotherapy for limited-stage small-cell lung cancer (LS-SCLC) with bulky tumor. From July 2012 to September 2015, a total of 68 patients with stage IIIA and IIIB SCLC who had completed 3-4 cycles of etoposide plus cisplatin/carboplatin and achieved clinical complete response (cCR) or clinical partial response (cPR) were randomized into the two groups equally. The concurrent group received radiotherapy combined with oral etoposide and cisplatin and the sequential group received sequential chemoradiotherapy. Thoracic radiotherapy was performed using intensity-modulated radiation therapy (IMRT) with 95% PTV 60Gy/30 times. After completing chemoradiotherapy, patients received prophylactic cranial irradiation. The primary endpoint was progression-free survival (PFS), and secondary endpoints included overall survival (OS) and toxicity. The median follow-up time was 63.3 months (95% confidence interval [CI], 50.8-75.8). Better PFS and OS were observed in concurrent group (median PFS, 26.0 months [95% CI, 9.0-43.0] versus 13.1 months [95%CI, 9.7-16.6], p=0.023; median OS, 35.0 months [95% CI, 25.4-44.6] versus 22.0 months [95% CI, 17.0-27.1], p=0.015). There was no significant difference in the incidence of radiation esophagitis and radiation pneumonitis between the two groups (p=0.795, p=0.525). This study demonstrated that after the completion of 3-4 cycles of chemotherapy with a remission, concurrent chemoradiotherapy with oral etoposide and cisplatin improved survival compared with sequential chemoradiotherapy in LS-SCLC with bulky tumor. ClinicalTrials.gov Identifier: NCT01745445.

Evaluation of Epigallocatechin-3-Gallate as a Radioprotective Agent During Radiotherapy of Lung Cancer Patients: A 5-Year Survival Analysis of a Phase 2 Study

“…The significant difference was not found between the EGCG and mLDG groups with regard to ADI and the maximum grade of ARIE. Similar to previous studies, there was an increasing trend in the severity of esophagitis with concurrent CRT compared with sequential CRT ( 28 ). It did not reach statistical significance due to the small number of participants; therefore no attempt was made in the study to evaluate the effect of EGCG on the toxicity of concurrent chemotherapy.…”

Effectiveness of CT radiomic features combined with clinical factors in predicting prognosis in patients with limited-stage small cell lung cancer

“…SCLCs are highly aggressive and malignant which lead to poor prognosis and hard to predict prognosis, even in LS-SCLC. Our research group has conducted numerous studies on the timing of radiotherapy [ 24 ], the target area of radiotherapy [ 25 , 26 ], radiotherapy techniques [ 27 ], treatment sequencing [ 28 ] and the number of cycles of chemotherapy [ 29 ] during chemoradiotherapy, as well as prophylactic cranial irradiation(PCI) [ 30 ] for SCLC. Our findings reveal the difficulty in accurately predicting the prognosis of LS-SCLC from a purely clinical standpoint.…”