Local Failure in Patients Treated with Radiotherapy and Multidrug Chemotherapy for Small Cell Lung Cancer

Brodin, Ola; Rikner, Göran; Steinholtz, Lena; E, Nõu

doi:10.3109/02841869009092993

Cited by 19 publications

(3 citation statements)

References 24 publications

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“…In fact, >80% of failures after RT during this period occurred in field, suggesting that inadequate radiation doses, rather than inadequate volumes, were the primary causes of intrathoracic recurrence (19). Therefore, the prevailing trend for RT in LS-SCLC during the past two decades has been to reduce the treatment field size while increasing the radiation dose.…”

Section: Discussionmentioning

confidence: 99%

Positron Emission Tomography/Computed Tomography-Guided Intensity-Modulated Radiotherapy for Limited-Stage Small-Cell Lung Cancer

Shirvani

Komaki

Heymach

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Purpose Omitting elective nodal irradiation from planning target volumes does not compromise outcomes in patients with non–small-cell lung cancer, but whether the same is true for those with limited-stage small-cell lung cancer (LS-SCLC) is unknown. Therefore, in the present study, we sought to determine the clinical outcomes and the frequency of elective nodal failure in patients with LS-SCLC staged using positron emission tomography/computed tomography and treated with involved-field intensity-modulated radiotherapy. Methods and Materials Between 2005 and 2008, 60 patients with LS-SCLC at our institution underwent disease staging using positron emission tomography/computed tomography before treatment using an intensity-modulated radiotherapy plan in which elective nodal irradiation was intentionally omitted from the planning target volume (mode and median dose, 45 Gy in 30 fractions; range, 40.5 Gy in 27 fractions to 63.8 Gy in 35 fractions). In most cases, concurrent platinum-based chemotherapy was administered. We retrospectively reviewed the clinical outcomes to determine the overall survival, relapse-free survival, and failure patterns. Elective nodal failure was defined as recurrence in initially uninvolved hilar, mediastinal, or supraclavicular nodes. Survival was assessed using the Kaplan-Meier method. Results The median age of the study patients at diagnosis was 63 years (range, 39–86). The median follow-up duration was 21 months (range, 4–58) in all patients and 26 months (range, 4–58) in the survivors. The 2-year actuarial overall survival and relapse-free survival rate were 58% and 43%, respectively. Of the 30 patients with recurrence, 23 had metastatic disease and 7 had locoregional failure. We observed only one isolated elective nodal failure. Conclusions To our knowledge, this is the first study to examine the outcomes in patients with LS-SCLC staged with positron emission tomography/computed tomography and treated with definitive intensity-modulated radiotherapy. In these patients, elective nodal irradiation can be safely omitted from the planning target volume for the purposes of dose escalation and toxicity reduction.

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Section: Discussionmentioning

confidence: 99%

Positron Emission Tomography/Computed Tomography-Guided Intensity-Modulated Radiotherapy for Limited-Stage Small-Cell Lung Cancer

Shirvani

Komaki

Heymach

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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“…Up until now, there are only 2 prospective studies especially designed to solve these problems 19, 20. Whereas results from retrospective studies of the 2‐dimensional radiotherapy and nonplatinum‐based chemotherapy era were not consistent with each other 21‐24…”

Section: Discussionmentioning

confidence: 99%

Omitting elective nodal irradiation and irradiating postinduction versus preinduction chemotherapy tumor extent for limited‐stage small cell lung cancer

Bao

Zhang

et al. 2011

Cancer

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BACKGROUND: Controversies exist with regard to thoracic radiotherapy volumes for limited-stage small cell lung cancer (SCLC). This study compared locoregional progression and overall survival between limited-stage SCLC patients who received thoracic radiotherapy to different target volumes after induction chemotherapy. METHODS: Chemotherapy consisted of 6 cycles of etoposide and cisplatin. After 2 cycles of etoposide and cisplatin, patients were randomly assigned to receive thoracic radiotherapy to either the postchemotherapy or prechemotherapy tumor extent as study arm or control. Elective nodal irradiation was omitted for both arms. Forty-five Gy/30Fx/ 19 days thoracic radiotherapy was administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients who achieved complete remission. An interim analysis was planned when the first 80 patients had been followed for at least 6 months, for consideration of potential inferiority in the study arm. RESULTS: Forty-two and 43 patients were randomly assigned to a study arm and a control, respectively. The local recurrence rates were 31.6% (12 of 38) and 28.6% (12 of 42), respectively (P ¼ .81). The isolated nodal failure rates were 2.6% (1 of 38) and 2.4% (1 of 42), respectively (P ¼ 1.00). All isolated nodal failure sites were in the ipsilateral supraclavicular fossa. Mediastinal N3 was the only factor to predict isolated nodal failure (P ¼ .004; odds ratio [OR], 29.33; 95% CI,. One-year and 3-year overall survival rates were 80.6%, 36.2%, and 78.9%, 36.4%, respectively (P ¼ .54). CONCLUSIONS: Preliminary results indicated that irradiated postchemotherapy tumor extent and omitted elective nodal irradiation did not decrease locoregional control in the study arm, and the overall survival difference was not statistically significant between the 2 arms. Further investigation is warranted. Cancer 2012;118:278-

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“…In patients in whom ''inadequate treatment portals'' of TRT were observed, it led to inferior local control and overall survival (OS). When, however, more sophisticated CT-based simulation techniques became available (20,21), significance of the dose delivered rather than the delineated target since tumor recurrences unequivocally predominated within the post-CHT volume. Therefore, temporal trends became obvious in that both out-of-trial and trial setting requested for somewhat limited TRT fields.…”

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confidence: 99%

Radiotherapy target volume for limited-disease small cell lung cancer: good news from the dark side of the moon

Jeremić¹,

Kiladze²,

Jeremić³

et al. 2020

Ann Transl Med

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Local Failure in Patients Treated with Radiotherapy and Multidrug Chemotherapy for Small Cell Lung Cancer

Cited by 19 publications

References 24 publications

Positron Emission Tomography/Computed Tomography-Guided Intensity-Modulated Radiotherapy for Limited-Stage Small-Cell Lung Cancer

Positron Emission Tomography/Computed Tomography-Guided Intensity-Modulated Radiotherapy for Limited-Stage Small-Cell Lung Cancer

Omitting elective nodal irradiation and irradiating postinduction versus preinduction chemotherapy tumor extent for limited‐stage small cell lung cancer

Radiotherapy target volume for limited-disease small cell lung cancer: good news from the dark side of the moon

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