Management of Small-Cell Lung Cancer with Radiotherapy—A Pan-Canadian Survey of Radiation Oncologists

Shahi, Jeevin; Wright, Jim; Gabos, Zsolt; Swaminath, Anand

doi:10.3747/co.23.3023

Cited by 30 publications

(29 citation statements)

References 47 publications

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“…Since then, the radiotherapy doses used in standard fractionation have increased to ∼60–66 Gy and a direct comparison between the higher dose standard-fractionation and the twice-daily schedule was missing. The potential inconvenience of twice-daily administration and the significantly increased rates of transient grade 3 esophagitis were the main concerns that explain why the twice-daily regimen was not universally adopted ( table 1 ) [ 30 , 31 ]. The recent CONVERT phase III trial did not demonstrate superiority of once daily radiotherapy with 66 Gy when compared to the aforementioned twice-daily regimen, with both regimens having very similar toxicity rates [ 29 ].…”

Section: Standard Of Care For Ld-sclcmentioning

confidence: 99%

The role of radiation therapy in the management of small cell lung cancer

Glatzer

Schmid

Radovic

et al. 2017

Breathe

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Small cell lung cancer (SCLC) is a very aggressive form of lung cancer. SCLC treatment requires multidisciplinary management and timely treatment. Radiation therapy is an important part of management of all stages of SCLC, in the curative as well as in the palliative setting. The role of radiation therapy in all stages of SCLC has changed in recent years; this article describes these changes and highlights the role of radiation therapy in the management of SCLC.

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Section: Standard Of Care For Ld-sclcmentioning

confidence: 99%

The role of radiation therapy in the management of small cell lung cancer

Glatzer

Schmid

Radovic

et al. 2017

Breathe

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“…1,[3][4][5][6][7] A variety of radiation therapy dose fractionation regimens are commonly used in CRT for LS-SCLC. 4,5,[8][9][10][11][12][13][14][15] Phase 3 clinical trial data support the use of both hyperfractionated radiation therapy (45 Gy in 30 twice-daily fractions) and high-dose conventionally fractionated radiation therapy (CFRT, 66 Gy in 33 daily fractions); these regimens appear to achieve comparable survival outcomes with similar toxicity profiles. 5,16 Alternatively, hypofractionated radiation therapy (HFRT) using !2.1 Gy per fraction is also practiced in certain parts of the world, with a common regimen being 40 Gy in 15 fractions.…”

Section: Introductionmentioning

confidence: 98%

“…5,16 Alternatively, hypofractionated radiation therapy (HFRT) using !2.1 Gy per fraction is also practiced in certain parts of the world, with a common regimen being 40 Gy in 15 fractions. 15 A phase 2 trial comparing HFRT to hyperfractionated radiation therapy demonstrated similar progression-free survival (PFS) and OS outcomes, although this study had a limited sample size, restricting its power. 17 There is currently no completed randomized clinical trial comparing HFRT to CFRT, yet HFRT remains the preferred radiation therapy schedule in several countries.…”

Section: Introductionmentioning

confidence: 99%

“…17 There is currently no completed randomized clinical trial comparing HFRT to CFRT, yet HFRT remains the preferred radiation therapy schedule in several countries. 15 HFRT may be preferred over CFRT or hyperfractionation because of a shorter overall treatment time, decreased resource utilization, and patient convenience with single daily visits. 18 In the absence of randomized evidence, nonrandomized evidence can be used judiciously after controlling for confounding factors that contribute to selection bias.…”

Section: Introductionmentioning

confidence: 99%

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Is There a Role for Hypofractionated Thoracic Radiation Therapy in Limited-Stage Small Cell Lung Cancer? A Propensity Score Matched Analysis

Zayed

Chen

Ali

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Various radiation schedules are used in concurrent chemoradiation therapy for limited-stage small cell lung cancer (LS-SCLC). Since there is currently no randomized evidence comparing hypofractionated radiation therapy (HFRT) and conventionally fractionated radiation therapy (CFRT), the aim of this study was to compare overall survival (OS), progression-free survival (PFS), and toxicity of HFRT and CFRT in LS-SCLC. Methods and Materials: Patients with LS-SCLC treated between 2000 and 2013 with HFRT (40 Gy/15 fractions, 45 Gy/15 fractions, 45 Gy/20 fractions) or CFRT (60 Gy/30 or 66 Gy/33 fractions) were included. Propensity scores were generated using a multivariable logistic regression model. Patients were matched on a 1:1 ratio with a caliper distance of 0.20. OS and PFS were estimated by the Kaplan-Meier method and compared using log-rank tests. As a sensitivity analysis, univariable and multivariable Cox regression was performed including all patients without matching. Logistic regression was performed to identify predictors of pulmonary and esophageal adverse events. Results: In the overall group of 117 patients, there were significant baseline differences between the HFRT and CFRT cohorts. Patients who received CFRT were older, more often smoked concurrently with treatment, had higher Eastern Cooperative Oncology Group performance status, different T and N stage patterns, and more commonly received concurrent chemoradiation therapy and prophylactic cranial irradiation. After propensity score matching for these differences, 72 patients were included, 36 in the HFRTand CFRT cohorts, respectively. There was no difference in OS (P Z .724), PFS (P Z .862), or any pulmonary (P Z .350) or esophageal (P Z .097) adverse events between cohorts. Skin adverse events were significantly higher for CFRT (41.7%) compared with HFRT (16.7%, P Z .020). Multivariable Cox regression also revealed no differences in OS (P Z .886) or PFS (P Z .717) between all HFRT and CFRT patients, without matching. No grade 5 adverse events were observed.

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“…Historically, twice-daily and once-daily radiotherapy regimes have evolved for SCLC side-by-side [55][56][57][58][59][60][61]. SCLC can be treated with daily radiotherapy (to 66 Gy) or with twice-daily treatment (to 45 Gy), both with a relatively favourable 3-year survival rate of ∼40% and similar toxicity rates [62].…”

Section: Radiochemotherapymentioning

confidence: 99%