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Retrospective Analysis of Chemoradiotherapy for Limited-Stage Small-Cell Lung Cancer

제한병기 소세포암 환자의 항암화학방사선요법에 대한 후향적 분석

  • Lee, Jong-Hoon (Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Sung-Hwan (Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Su-Zy (Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Joo-Hwan (Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Hoon-Kyo (Departments of Medical Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine) ;
  • Shim, Byoung-Yong (Departments of Medical Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine)
  • 이종훈 (가톨릭대학교 의과대학 성빈센트병원 방사선종양학교실) ;
  • 김성환 (가톨릭대학교 의과대학 성빈센트병원 방사선종양학교실) ;
  • 김수지 (가톨릭대학교 의과대학 성빈센트병원 방사선종양학교실) ;
  • 이주환 (가톨릭대학교 의과대학 성빈센트병원 방사선종양학교실) ;
  • 김훈교 (가톨릭대학교 의과대학 성빈센트병원 종양내과학교실) ;
  • 심병용 (가톨릭대학교 의과대학 성빈센트병원 종양내과학교실)
  • Received : 2009.07.03
  • Accepted : 2009.08.26
  • Published : 2009.09.30

Abstract

Purpose: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. Results: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). Conclusion: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.

References

  1. Elias AD. Small cell lung cancer: state-of-the-art therapy in 1996. Chest 1997;112(Suppl. 4):S251-258 https://doi.org/10.1378/chest.112.4_Supplement.251S
  2. Sierocki JS, Hilaris BS, Hopfan S, et al. cis-Dichlorodiammineplatinum (II) and VP-16-213: an active induction regimen for small cell carcinoma of the lung. Cancer Treat Rep 1979;63:1593-1597
  3. Eagan RT, Ingle JN, Frytak S, et al. Platinum-based polychemotherapy versus dianhydrogalactitol in advanced nonsmall cell lung cancer. Cancer Treat Rep 1977;61:1339-1345
  4. Pignon JP, Arriagada R, Ihde D, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 1992;327:1618-1624 https://doi.org/10.1056/NEJM199212033272302
  5. Komaki R, Byhardt RW, Anderson T, et al. What is the lowest effective biologic dose for prophylactic cranial irradiation? Am J Clin Oncol 1985;8:523-527 https://doi.org/10.1097/00000421-198512000-00013
  6. World Health Organization. Handbook for Reporting Results of Cancer Treatment (WHO Offset Publication No. 48). Geneva: World Health Organization, 1979
  7. Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-481 https://doi.org/10.2307/2281868
  8. Peto R, Pike M. Conservatism of the approximation S (O-E)2/E in the log-rank test for survival data or tumour incidence data. Biometrics 1973;29:759-784
  9. Cox D, Snell E. Analysis of Binary Data. 2nd ed. London;Chapman & Hall, 1989
  10. Cox DR. Regression models and life table. J R Stat Soc B 1972;34:181-220
  11. Lee CG, Kim JH, Suh CO, et al. Randomized trial of early versus late alternative radiotherapy/chemotherapy in limiteddisease patients with small cell lung cancer. J Korean Soc Ther Radiol Oncol 2002;20:116-122
  12. Kim SH, Choi BO, Gil HJ, et al. The results of radiation therapy of limited stage small cell lung cancer. J Korean Soc Ther Radiol Oncol 1993;11:97-102
  13. Bunn PA Jr, Lichter AS, Makuch RW, et al. Chemotherapy alone or chemotherapy with chest radiation therapy in limited stage small cell lung cancer: a prospective, randomized trial. Ann Intern Med 1987;106:655-662 https://doi.org/10.7326/0003-4819-106-5-655
  14. Greco FA, Brereton HD, Kent H, et al. Adriamycin and enhanced radiation reaction in normal esophagus and skin. Ann Intern Med 1976;85:294-298 https://doi.org/10.7326/0003-4819-85-3-294
  15. Perez CA, Einhorn L, Oldham RK, et al. Randomized trial of radiotherapy to the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report. J Clin Oncol 1984;2:1200-1208 https://doi.org/10.1200/JCO.1984.2.11.1200
  16. Turrisi AT III, Kim K, Blum R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 1999;340:265-271 https://doi.org/10.1056/NEJM199901283400403
  17. Takada M, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 2002;20:3054-3060 https://doi.org/10.1200/JCO.2002.12.071
  18. Murray N, Coy P, Pater JL, et al. The importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. J Clin Oncol 1993;11:336-344
  19. Perry MC, Eaton WL, Propert KJ, et al. Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med 1987;316:912-918 https://doi.org/10.1056/NEJM198704093161504
  20. Spiro SG, James LE, Rudd RM, et al. Early compared with late radiotherapy in combined modality treatment for limited disease small-cell lung cancer: a London Lung Cancer Group multicenter randomized clinical trial and met-analysis. J Clin Oncol 20060;24:3823-3830 https://doi.org/10.1200/JCO.2005.05.3181
  21. Fried DB, Morris DE, Poole C, et al. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer. J Clin Oncol 2004;22:4837-4845 https://doi.org/10.1200/JCO.2004.01.178