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http://dx.doi.org/10.3857/roj.2017.00311

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)
Publication Information
Radiation Oncology Journal / v.36, no.1, 2018 , pp. 35-44 More about this Journal
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
Small cell lung carcinoma; Chemoradiotherapy; Radiotherapy dosage;
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1 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.   DOI
2 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.   DOI
3 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.   DOI
4 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.   DOI
5 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.   DOI
6 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.   DOI
7 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.
8 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.
9 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.   DOI
10 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.   DOI
11 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.   DOI
12 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.   DOI
13 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.
14 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.   DOI
15 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.   DOI
16 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.   DOI
17 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.   DOI
18 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.   DOI
19 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.   DOI
20 Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016;66:271-89.   DOI
21 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30.   DOI
22 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.   DOI
23 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.   DOI
24 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.   DOI
25 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.   DOI
26 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.   DOI
27 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.   DOI