Effect of radiotherapy on the treatment of patients with extensive stage small cell lung cancer

Wu, Chao; Wang, T.; Wang, J.; Qu, Bo; Wang, H.; Hu, Yu-Jie

doi:10.4238/2014.january.24.7

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…As a result, leading to relapse and metastasis, therefore patients have higher recurrence 23 . Platinum-based chemotherapy combined with TRT significantly improved OS and PFS in ES-SCLC patients 4 , 16 , 20 , 24 , 25 .…”

Section: Discussionmentioning

confidence: 92%

“…In the past when applying simple platinum-based chemotherapy as a standard treatment for ES-SCLC, thoracic radiotherapy was used only to palliate local symptoms and to improve quality of life 26 . Several clinical trials have demonstrated platinum-based chemotherapy combined with TRT to improve the prognosis of ES-SCLC patients 4 , 16 , 20 , 24 , 25 . According to the previous literatures 4 , 16 , 20 , 24 , 25 , the 2-year OS of patients with ES-SCLC who received chemotherapy plus TRT increased from 13% to 38%.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical trials have demonstrated platinum-based chemotherapy combined with TRT to improve the prognosis of ES-SCLC patients 4 , 16 , 20 , 24 , 25 . According to the previous literatures 4 , 16 , 20 , 24 , 25 , the 2-year OS of patients with ES-SCLC who received chemotherapy plus TRT increased from 13% to 38%. For patients with a single chemotherapy regimen, when treated with additional TRT, the 2-year OS shows enhancement from 6% to 21% 4 , 10 , 16 , 25 .…”

Section: Discussionmentioning

confidence: 99%

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Thoracic radiotherapy (TRT) improved survival in both oligo- and polymetastatic extensive stage small cell lung cancer

Cheng

Kang

et al. 2017

Sci Rep

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There has been no previous study on the efficacy of the thoracic radiotherapy (TRT) in oligometastatic or polymetastatic extensive stage small-cell lung cancer (ES-SCLC) to the overall survival (OS). In a group of 270 ES-SCLC cases retrospective study, 78 patients (28.9%) had oligometastases and 192 (71.1%) had polymetastases, among which 51 oligometastatic patients (65.4%) and 93 polymetastatic patients (51.6%) received TRT. Propensity score matching (PSM) was utilized. The 2-year OS, progression free survival (PFS) and local control (LC) in oligometastatic and polymetastatic patients were 22.8% and 4.5% (p < 0.001), 12.0% and 3.8% (p < 0.001), and 36.7% and 6.1% (p < 0.001), respectively. The 2-year OS in oligometastatic patients with the chemotherapy + radiotherapy and chemotherapy alone were 25.2% and 12.7% (p = 0.002), in contrast to 10.0% and 6.8% (p = 0.030) in polymetastatic patients. The estimated hazard ratios for survival were 2.9 and 1.7 for both oligometastatic and polymetastatic patients with radiotherapy. The polymetastatic group has a lower LC (6.1% v.s. 36.7%, (p < 0.001)), due to polymetastases patients receiving involved-sites radiotherapy with low dose schemas. TRT improved OS of patients with oligometastases and polymetastases. Our study demonstrated that aggressive TRT might be a suitable addition of chemotherapy when treating ES-SCLC patients with oligometastases and polymetastases.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Thoracic radiotherapy (TRT) improved survival in both oligo- and polymetastatic extensive stage small cell lung cancer

Cheng

Kang

et al. 2017

Sci Rep

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“…The treatment of choice is the radiation therapy for the patients with extensive disease, for the metastatic sites and especially for the bones, the epidural, and the brain, which in this case the patients are treated with whole-brain radiation therapy. [70] The group of patients, with extensive disease, who submitted in chemotherapy and they revealed any response, they should be undergo assessment for thoracic radiation therapy. There is a big randomized trial, in which almost 500 patients after completing the chemotherapy schema, they randomized to receive radiation therapy or observation.…”

Section: Radiation Therapymentioning

confidence: 99%

Small Cell Lung Cancer: Current and Future Strategies

Lampaki¹,

Lagoudi²,

Tsavlis³

et al. 2016

Oncomedicine

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Small cell lung cancer (SCLC) represents approximately 15% of all lung cancer diagnoses and over the last 20 years, in the Western world, the proportion of patients with SCLC has decreased to 13% due to world campaign for smoking cessation. Due to high growth fraction of the disease, to early dissemination with widespread metastases and also to early development of drug resistance, the treatment of SCLC remains discouraging. The median survival time without treatment is 2-4 months and with treatment the 5-year survival rate remains low at <7% overall and the most of the patients relapse within one year after first-line treatment. Chemotherapy with a platinum regimen and etoposide is the gold of standard of treatment for limited (LD) and extensive disease (ED), by adding radical thoracic radiotherapy for patients with good performance status, with LD. The new TNM classification should be used also for SCLC. For the patients who have any response is indicated the prophylactic cranial irradiation (PCI) due to high risk of brain metastases. The benefit from second-line therapy is limited and maintenance therapy did not appear to improve overall survival (OS) or progression free survival (PFS) for patients with SCLC. Many targeted agents have been investigated in LD and ED, almost all of them in unselected populations, but also with pessimistic results. Due to unchanged therapeutic options for almost four decades, is required desperately to understand better the molecular basis of SCLC and to proceed in to clinical trials for new drugs and targeted agents.

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“…Moreover, the RTOG 0937 study and NTR1527 trial emphasized that TRT should be performed for ES-SCLC patients who responded to chemotherapy [8]. Several retrospective analyses also suggested that TRT in combination with chemotherapy was associated with long-term survival [9][10][11][12][13]. Recently, the additional use of TRT has been strongly advocated for certain ES-SCLC patients after chemotherapy treatment in the 2020 NCCN guidelines [14] and in the ASTRO 2020 guidelines [15].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Extensive Stage Small Cell Lung Cancer Patients Treated With Thoracic Radiotherapy at Different Timing and Fractionation

Han

2020

Preprint

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Objective: The purpose of this study was to assess whether combined thoracic radiotherapy (TRT) on the basis of chemotherapy (ChT) showed promising anti-tumor activity in extensive-stage small cell lung cancer (ES-SCLC), then to explore practice patterns for radiation time and dose/ fractionation and to identify prognostic factors for patients who would benefit from ChT/TRT.Methods: A total of 492 ES-SCLC patients were included from January 2010 to March 2019, of which 244 patients experienced ChT/TRT. Propensity score matching (PSM) was performed to minimize bias between the ChT/TRT and ChT-alone groups. Patients in ChT/TRT group were categorized into four groups based on the number of induction chemotherapy cycles. For effective dose fractionation calculation, we introduced the time-adjusted biological effective dose(tBED). Categorical variables were analyzed with Chi-square tests and Fisher’s exact tests. Survival rates were computed by the Kaplan-Meier method. Multivariate prognostic analysis was performed with Cox proportional hazard models. Results: Patients who received ChT/TRT were associated with improved OS (18.2 vs 10.8 months), PFS (9.0 vs 6.0 months) and LRFS (12.0 vs 6.0 months) before matching, with similar results after matching. In the ChT/TRT group, the median LRFS times for groups based on radiation time were 12.7, 12.0, 12.7, and 9.0 months, respectively. Earlier TRT had a tendency to prolong PFS (median 10.6 vs 9.8 vs 9.1 vs 7.7 months, respectively, p = 0.1095), as was not seen in OS (median 17.6 vs 19.5 vs 17.2 vs 19.1 months, respectively, p = 0.7224). To note, patients within 6 cycles had better LRFS (p = 0.0006). For radiation dose, patients in high-dose group (tBED>50Gy) had worse OS (median 25.9 vs 22.9, p = 0.0484) and PFS (median 12.1 vs 11.2, p=0.0042) in patients with complete response and partial response (CR and PR) to systemic therapy, but the above-mentioned results were not drawn when the population was confined to those receiving standard fractionation with CR and PR. Conclusion: ChT/TRT could improve survival for ES-SCLC patients. We cautiously recommend that TRT should be performed within 6 cycles and receiving hyperfractionated 45Gy in 30 fractions may be a feasible treatment scheme for ES-SCLC patients.

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Effect of radiotherapy on the treatment of patients with extensive stage small cell lung cancer

Cited by 8 publications

References 19 publications

Thoracic radiotherapy (TRT) improved survival in both oligo- and polymetastatic extensive stage small cell lung cancer

Thoracic radiotherapy (TRT) improved survival in both oligo- and polymetastatic extensive stage small cell lung cancer

Small Cell Lung Cancer: Current and Future Strategies

Clinical Outcomes of Extensive Stage Small Cell Lung Cancer Patients Treated With Thoracic Radiotherapy at Different Timing and Fractionation

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