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Impact of radiation dose on concurrent chemoradiotherapy for limited-stage small-cell lung cancer

  • Park, Junhee (Department of Radiation Oncology, School of Medicine, Kyungpook National University) ;
  • Kang, Min Kyu (Department of Radiation Oncology, School of Medicine, Kyungpook National University)
  • Received : 2017.06.09
  • Accepted : 2017.09.13
  • Published : 2018.03.31

Abstract

Purpose: To evaluate clinical outcomes according to radiation dose in patients with limited-stage small-cell lung cancer (LS-SCLC) treated with concurrent chemoradiotherapy (CCRT). Materials and Methods: From January 2006 to December 2015, 38 patients with LS-SCLC were treated with CCRT with etoposide and cisplatin. Total radiation doses ranged from 45 Gy to 66 Gy (1.8-2 Gy/fraction) and were classified into three groups: 45-54 Gy, 60-63 Gy, and 66 Gy. The impact of radiation dose on survival outcomes were evaluated. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.03. Results: The median follow-up period was 21 months. The 2-year overall survival (OS) and local failure-free survival (LFFS) rates were 45.8% and 67.5%, respectively. The 2-year LFFS rates were 33.3% for 45-54 Gy group, 68.6% for 60-63 Gy group, and 87.1% for 66 Gy group (p = 0.014). In multivariate analysis, radiation dose was a significant factor for LFFS (p = 0.015). Although radiation dose was not a significant factor for OS and disease-free survival (DFS) in multivariate analysis, both OS and DFS of 66 Gy group tended to be better than that of 45-63 Gy group in univariate analysis. However, there were no differences in severe toxicities among three groups. Conclusion: Higher radiation dose achieved better local control in patients with LS-SCLC treated with CCRT. In addition, a total dose of 66 Gy tended to improve OS and DFS.

Keywords

References

  1. Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016;66:271-89. https://doi.org/10.3322/caac.21349
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30. https://doi.org/10.3322/caac.21332
  3. Pignon JP, Arriagada R, Ihde DC, et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 1992;327:1618-24. https://doi.org/10.1056/NEJM199212033272302
  4. Warde P, Payne D. Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 1992;10:890-5. https://doi.org/10.1200/JCO.1992.10.6.890
  5. 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;20:3054-60. https://doi.org/10.1200/JCO.2002.12.071
  6. Roof KS, Fidias P, Lynch TJ, Ancukiewicz M, Choi NC. Radiation dose escalation in limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 2003;57:701-8. https://doi.org/10.1016/S0360-3016(03)00715-6
  7. Tomita N, Kodaira T, Hida T, et al. The impact of radiation dose and fractionation on outcomes for limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 2010;76:1121-6. https://doi.org/10.1016/j.ijrobp.2009.03.069
  8. Frytak S, Shaw EG, Jett JR, et al. Infusion cisplatin chemotherapy and hyperfractionated thoracic radiotherapy for small-cell lung cancer. Am J Clin Oncol 1996;19:193-8. https://doi.org/10.1097/00000421-199604000-00022
  9. Johnson DH, Turrisi AT, Chang AY, et al. Alternating chemotherapy and twice-daily thoracic radiotherapy in limited-stage small-cell lung cancer: a pilot study of the Eastern Cooperative Oncology Group. J Clin Oncol 1993;11:879-84. https://doi.org/10.1200/JCO.1993.11.5.879
  10. Schild SE, Bonner JA, Shanahan TG, et al. Long-term results of a phase III trial comparing once-daily radiotherapy with twice-daily radiotherapy in limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004;59:943-51. https://doi.org/10.1016/j.ijrobp.2004.01.055
  11. Choi NC, Herndon JE 2nd, Rosenman J, et al. Phase I study to determine the maximum-tolerated dose of radiation in standard daily and hyperfractionated-accelerated twicedaily radiation schedules with concurrent chemotherapy for limited-stage small-cell lung cancer. J Clin Oncol 1998;16:3528-36. https://doi.org/10.1200/JCO.1998.16.11.3528
  12. Komaki R, Swann RS, Ettinger DS, et al. Phase I study of thoracic radiation dose escalation with concurrent chemotherapy for patients with limited small-cell lung cancer: report of Radiation Therapy Oncology Group (RTOG) protocol 97-12. Int J Radiat Oncol Biol Phys 2005;62:342-50. https://doi.org/10.1016/j.ijrobp.2004.11.030
  13. Salama JK, Hodgson L, Pang H, et al. A pooled analysis of limited-stage small-cell lung cancer patients treated with induction chemotherapy followed by concurrent platinumbased chemotherapy and 70 Gy daily radiotherapy: CALGB 30904. J Thorac Oncol 2013;8:1043-9. https://doi.org/10.1097/JTO.0b013e318293d8a4
  14. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  15. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) v4.03 [Internet]. Bethesda, MD: National Cancer Institute; c2017 [cited 2018 Jan 20]. Available from: https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.
  16. McCracken JD, Janaki LM, Crowley JJ, et al. Concurrent chemotherapy/radiotherapy for limited small-cell lung carcinoma: a Southwest Oncology Group Study. J Clin Oncol 1990;8:892-8. https://doi.org/10.1200/JCO.1990.8.5.892
  17. Turrisi AT 3rd, 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;340:265-71. https://doi.org/10.1056/NEJM199901283400403
  18. ClinicalTrials.gov. Phase III comparison of thoracic radiotherapy regimens in patients with limited small cell lung cancer also receiving cisplatin and etoposide [Internet]. Bethesda, MD: National Library of Medicine; c2017 [cited 2017 Aug 20]. Available from: https://clinicaltrials.gov/ct2/show/NCT00632853?term=calgb+30610&rank=1.
  19. Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent oncedaily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an openlabel, phase 3, randomised, superiority trial. Lancet Oncol 2017;18:1116-25. https://doi.org/10.1016/S1470-2045(17)30318-2
  20. Choi NC, Carey RW. Importance of radiation dose in achieving improved loco-regional tumor control in limited stage smallcell lung carcinoma: an update. Int J Radiat Oncol Biol Phys 1989;17:307-10. https://doi.org/10.1016/0360-3016(89)90444-6
  21. Choi NC, Herndon J, Rosenman J, et al. Long term survival data from CALGB 8837: radiation dose escalation and concurrent chemotherapy (CT) in limited stage small cell lung cancer (LDSCLC): possible radiation dose-survival relationship [abstract]. Proc Am Soc Clin Oncol 2002;21:1190.
  22. Rutter CE, Park HS, Corso CD, et al. Comparison of survival outcomes among standard radiotherapy regimens in limitedstage small cell lung cancer patients receiving concurrent chemoradiation. Lung Cancer 2015;90:243-8. https://doi.org/10.1016/j.lungcan.2015.08.002
  23. Salama JK, Pang H, Bogart JA, et al. Predictors of pulmonary toxicity in limited stage small cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy: CALGB 30904. Lung Cancer 2013;82:436-40. https://doi.org/10.1016/j.lungcan.2013.10.001
  24. De Ruysscher D, Bremer RH, Koppe F, et al. Omission of elective node irradiation on basis of CT-scans in patients with limited disease small cell lung cancer: a phase II trial. Radiother Oncol 2006;80:307-12. https://doi.org/10.1016/j.radonc.2006.07.029
  25. Colaco R, Sheikh H, Lorigan P, et al. Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer: evidence from a phase II trial. Lung Cancer 2012;76:72-7. https://doi.org/10.1016/j.lungcan.2011.09.015
  26. Shirvani SM, Komaki R, Heymach JV, Fossella FV, Chang JY. Positron emission tomography/computed tomography-guided intensity-modulated radiotherapy for limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 2012;82:e91-7. https://doi.org/10.1016/j.ijrobp.2010.12.072
  27. Liu Z, Liu W, Ji K, Wang P, Wang X, Zhao L. Simultaneous integrated dose reduction intensity-modulated radiotherapy applied to an elective nodal area of limited-stage small-cell lung cancer. Exp Ther Med 2015;10:2083-7. https://doi.org/10.3892/etm.2015.2835

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