Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis.

Warde, Padraig; Payne, David G.

doi:10.1200/jco.1992.10.6.890

Cited by 740 publications

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“…This may in part reflect lower use of radiotherapy, which has an established role in consolidating the response of the primary tumour to chemotherapy and in reducing the risk of brain metastases as a site of recurrence. (Pignon et al, 1992;Warde and Payne, 1992). Cisplatin plays a central role in concurrent treatment, because of its radiosensitising effect, and there is increasing evidence of a survival benefit for patients receiving early, concurrent, cisplatin-based chemoradiotherapy with 5-year survival ranging between 20 and 25% (Fried et al, 2004;Pijls-Johannesma et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Phase III randomised trial of doxorubicin-based chemotherapy compared with platinum-based chemotherapy in small-cell lung cancer

et al. 2008

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This randomised trial compared platinum-based to anthracycline-based chemotherapy in patients with small-cell lung cancer (limited or extensive stage) and p2 adverse prognostic factors. Patients were randomised to receive six cycles of either ACE (doxorubicin 50 mg/m 2 i.v., cyclophosphamide 1 g/m 2 i.v. and etoposide 120 mg/m 2 i.v. on day 1, then etoposide 240 mg/m 2 orally for 2 days) or PE (cisplatin 80 mg/m 2 and etoposide 120 mg/m 2 i.v. on day 1, then etoposide 240 mg/m 2 orally for 2 days) given for every 3 weeks. For patients where cisplatin was not suitable, carboplatin (AUC6) was substituted. A total of 280 patients were included (139 ACE, 141 PE). The response rates were 72% for ACE and 77% for PE. One-year survival rates were 34 and 38% (P ¼ 0.497), respectively and 2-year survival was the same (12%) for both arms. For LD patients, the median survival was 10.9 months for ACE and 12.6 months for PE (P ¼ 0.51); for ED patients median survival was 8.3 months and 7.5 months, respectively. More grades 3 and 4 neutropenia (90 vs 57%, Po0.005) and grades 3 and 4 infections (73 vs 29%, Po0.005) occurred with ACE, resulting in more days of hospitalisation and greater i.v. antibiotic use. ACE was associated with a higher risk of neutropenic sepsis than PE and with a trend towards worse outcome in patients with LD, and should not be studied further in this group of patients.

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Section: Discussionmentioning

confidence: 99%

Phase III randomised trial of doxorubicin-based chemotherapy compared with platinum-based chemotherapy in small-cell lung cancer

et al. 2008

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“…Two meta-analyses have established the function of TRT in the management of patients with LD (Pignon et al, 1992;Warde and Payne, 1992). Both reports found an improved intrathoracic tumour control rate with combined modality patients and statistically improved survival with an absolute benefit in overall survival (OS) at 3 years (Pignon et al, 1992) and 2 years (Warde and Payne, 1992) of 5.4%. Treatmentrelated toxicity is worse with combination treatments, but is acceptable in patients with a good PS.…”

Section: Chemoradiationmentioning

confidence: 99%

Treatment options for small cell lung cancer – do we have more choice?

et al. 2010

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“…TREATMENT Currently, the standard treatment for LD-SCLC for unselected patients consists of four to six cycles of a platinumbased chemotherapy regimen combined with thoracic radiotherapy (RT) of the tumor region and the mediastinum, which is followed by prophylactic cranial irradiation (PCI) in cases of complete remission [38][39][40]. The concurrent (versus sequential) approach seems to offer better survival [38,41].…”

Section: Multidimensional Assessmentmentioning

confidence: 99%

Treatment of Small Cell Lung Cancer in the Elderly

et al. 2005

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Small cell lung cancer (SCLC) accounts for approximately 20% of lung carcinomas. Chemotherapy is the cornerstone of treatment for SCLC. In limited disease, the median survival time is about 12-16 months, with a 4%-5% long-term survival rate; in extensive disease the median survival time is 7-11 months. More than 50% of lung cancer patients are diagnosed when they are over the age of 65, and about 30% are over 70. Elderly patients tolerate chemotherapy poorly compared with their younger counterparts, because of agerelated progressive reductions in organ function and comorbidities. The standard therapy for limited disease is combined chemoradiotherapy, followed by prophylactic brain irradiation for patients achieving complete responses. In the elderly, the addition of radiotherapy to chemotherapy must be carefully evaluated, considering the slight survival benefit and potential for substantial toxicity incurred with this treatment. The best approach is to design clinical trials that specifically include geriatric assessment to develop active and well-tolerated chemotherapy regimens for elderly SCLC patients. Survival improvement for SCLC patients requires a better understanding of tumor biology and the subsequent development of novel therapeutic strategies. Several targeted agents have been introduced into clinical trials in SCLC, but a minority of these new agents offers a promise of improved outcomes, and negative results are reported more commonly than positive ones. This review focuses on the main issues in the treatment of elderly SCLC patients. The Oncologist 2005;10:399-411The Oncologist 2005;10:399-411 www.TheOncologist.com

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Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis.

Abstract: This meta-analysis shows a small but significant improvement in survival and a major improvement in tumor control in the thorax in patients receiving thoracic radiation therapy. However, this is achieved at the cost of a small increase in treatment-related mortality.

Cited by 740 publications

References 0 publications

Phase III randomised trial of doxorubicin-based chemotherapy compared with platinum-based chemotherapy in small-cell lung cancer

Phase III randomised trial of doxorubicin-based chemotherapy compared with platinum-based chemotherapy in small-cell lung cancer

Treatment options for small cell lung cancer – do we have more choice?

Treatment of Small Cell Lung Cancer in the Elderly

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