Thoracic radiation therapy improves the overall survival of patients with extensive-stage small cell lung cancer with distant metastasis

Abstract

BACKGROUND:The authors conducted a retrospective study to evaluate the effects of thoracic radiation therapy (TRT) for patients with extensive-stage small cell lung cancer (ED-SCLC). METHODS: Between January 2003 and December 2006, the records of 119 patients who were diagnosed with ED-SCLC (all with distant metastasis [M1]) were included in the study. Sixty patients received chemotherapy (ChT) and TRT (ChT/TRT), and 59 patients received ChT alone. The ChT regimens consisted of either carboplatin and etoposide (CE) or cisplatin and etoposide (PE). The total dose of TRT ranged from 40 to 60 grays (Gy) at 1.8 to 2.0 Gy per fraction. RESULTS: For the entire group, the median survival was 13 months, and the 2-year and 5-year overall survival (OS) rates were 26.1% and 6.5%, respectively. The median survival and the 2-year and 5-year OS rates were 17 months, 35%, and 7.1%, respectively, in the ChT/TRT group and 9.3 months, 17%, and 5.1%, respectively, in the ChT group (P ¼ .014). However, this improvement was achieved at the expense of low toxicity. Multivariate analysis revealed that receiving 4 cycles of ChT (P ¼ .032) and TRT (P ¼ .005) were favorable prognostic factors for OS. Of all toxicities, only high-grade leucopenia (grade >3) was more frequent in the ChT/TRT group. CONCLUSIONS: The addition of TRT to ChT improved the OS of patients with ED-SCLC. Furthermore, receiving 4 cycles of ChT and TRT were independent, favorable prognostic factors for OS.

Thoracic Radiotherapy for Extensive Stage Small-Cell Lung Cancer: A Meta-Analysis

“…The optimal dose of TRT is uncertain. Higher doses of TRT appear to be associated with a high risk of esophagitis [16], and this is in keeping with a previous meta-analysis indicating that in non-small cell lung cancer, high-dose metrics (such as the volume of esophagus receiving 60 Gy) are the best predictors of esophagitis risk [20]. Although higher TRT doses may be associated with increased toxicity risk, benefits of such an TRT dose escalation would be ideally assessed in the context of a randomized trial.…”

“…TRT doses ranged from 40 to 60 Gy. On multivariable analysis, the use of TRT was associated with improved OS (HR 0.66, p=0.032), at the expense of higher rates of pneumonitis (8% grade 2-5, with one death), esophagitis (22% grade 2-3), and leukopenia[16].…”

Current standards for clinical management of small cell lung cancer

“…A single-institution randomized trial (67) demonstrated an improvement in both local control and OS in patients with a complete distant response and at least partial local response to chemotherapy who received chemotherapy with concurrent thoracic radiotherapy and PCI versus continued chemotherapy and PCI. A single-arm phase II trial (68) and retrospective series also demonstrated an improvement in local disease control with thoracic radiotherapy in carefully selected populations of patients with limited extra-thoracic disease burden (69,70). The CREST Trial/NTR1527 (71) randomized 498 patients with ES-SCLC and response to chemotherapy to thoracic radiotherapy to 30 Gy in 10 fractions and PCI versus PCI alone.…”

Therapeutic Potential of Umbilical Cord Mesenchymal Stem Cells for Inhibiting Myofibroblastic Differentiation of Irradiated Human Lung Fibroblasts

“…Radiotherapy has a well-established and indispensable role in the treatment of small cell lung cancer (Zhu et al 2011). However, radiation-induced lung injury (RILI) is a major adverse effect associated with radiotherapy for lung cancer, limiting the therapeutic dose of radiation that can be administered.…”