70 Gy Thoracic Radiotherapy (TRT) is Feasible Concurrent with Chemotherapy for Limited Stage Small Cell Lung Cancer (L-SCLC): Preliminary Analysis of a CALGB Phase II Trial

Reviewer: William Levin, MD
OncoLink
Ultima Vez Modificado: 9 de octubre del 2002

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Presenter: J.A. Bogart
Presenter's Affiliation: Upstate Medical University, Syracuse, NY, USA
Type of Session: Scientific

Background

  • This study was designed to further investigate the optimal treatment regimen for L-SCLC.
  • A previous randomized intergroup trial showed a survival benefit for twice-daily TRT (total 45 Gy) with chemotherapy, versus chemotherapy and once daily radiation therapy (total 45 Gy).
  • The current study was designed to prospectively study the feasibility and efficacy of 70 Gy/in once-daily fractions with concurrent chemotherapy.

Materials and Methods

  • 63 patients were enrolled on the study. They received 70 Gy in TRT in 2 Gy per day fractions. Patients received 2 cycles of Taxol prior to TRT. They then received 3 cycles of carboplatin/etoposide concurrently with TRT.
  • Prophylactic cranial irradiation (PCI) was given to those patients with a CR or good PR to therapy.
  • TRT was to the post-induction chemotherapy volume.

Results

  • Median follow-up is 18.4 months.
  • Mean age was 60 years.
  • 90% of patients proceeded to TRT following induction chemotherapy.
  • One fatality occurred on treatment during the TRT phase.
  • Non-hematologic grade 3/4 toxicities were seen in 10% of patients.
  • Febrile neutropenia was seen in 16% of patients.
  • No grade 4 pulmonary toxicity has been reported.
  • 65% of patients experienced a CR or sustained PR (stable for 6 months or more).

Author's Conclusions

  • 70 Gy/once daily TRT can safely be given with concurrent chemotherapy for L-SCLC.
  • Longer follow-up is necessary before drawing conclusions regarding efficacy.

Clinical/Scientific Implications

  • Short term analysis of this study suggests that once-daily radiation given to 70 Gy with chemotherapy may be possible, but again, follow-up is short.
  • Once-daily high dose TRT treatments, if safe and effective, would need to be tested against the current standard regimen of BID irradiation in patients with excellent performance status.

Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Ortho Biotech.

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Oct 1, 2014 - In patients with non-small cell lung cancer, prophylactic cranial irradiation may help prevent brain metastases, and stereotactic radiotherapy may arrest the growth of lung cancer in frail patients, according to research presented at the 51st Annual Meeting of the American Society for Radiation Oncology, held from Nov. 1 to 5 in Chicago.



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