Standard vs. Higher-Dose Consolidative Thoracic Radiation in Extensive-Stage Small Cell Lung Cancer
| Autor: | Abraham J. Wu, Charles M. Rudin, D. Billing, Andreas Rimner, V. Lai, Daniel R. Gomez, Narek Shaverdian, Annemarie F. Shepherd, Charles B. Simone, Daphna Y. Gelblum |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Cancer Research
medicine.medical_specialty Chemotherapy Radiation business.industry Incidence (epidemiology) medicine.medical_treatment Urology Retrospective cohort study medicine.disease Oncology Cohort Toxicity medicine Radiology Nuclear Medicine and imaging Progression-free survival Prophylactic cranial irradiation business Esophagitis |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 111:e464-e465 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2021.07.1300 |
| Popis: | Purpose/Objective(s) The CREST trial demonstrated improvement in progression free survival (PFS) with consolidative thoracic radiation (TRT) in extensive stage small cell lung cancer (ES-SCLC) using a dose of 30Gy in 10 fractions. However, observed rates of intrathoracic recurrence remained high, occurring in > 40% of patients. These results, and the higher doses used in earlier studies of consolidative TRT, suggest that doses > 30Gy may provide superior progression free survival and local control. Materials/Methods A single institution review of all consecutive patients with ES-SCLC who received consolidative TRT between 2010 and 2019 was performed. Consolidative TRT was defined as treatment occurring concurrently or sequentially with first-line chemotherapy. TRT for progression of disease was excluded. Baseline characteristics, toxicity, and outcome data were collected. Patients were sorted into two cohorts based on radiation dose: “standard” if treated with 30 Gy in 10 fractions, or “escalated” if treated with > 30 Gy. Overall survival (OS), PFS, and incidence of local failure were analyzed with log-rank and Gray tests. Results A total of 71 patients who met inclusion criteria were identified. Of these, 54 received the standard dose and 17 received escalated dose. The median dose in the escalated cohort was 45 Gy (range 36 – 70 Gy) and the median dose per fraction was 3 Gy (range 1.5 – 10 Gy). Two patients in the escalated cohort received concurrent chemoradiation in twice-daily fractions, whereas the remainder of the patients in both cohorts received sequential chemoradiation with once-daily fractions. Patients in the escalated cohort were younger (median age 62.5 vs. 66 years, P = 0.05). Otherwise, cohort characteristics were well balanced in terms of sex, pre-TRT Karnofsky performance status, number of pre-TRT chemotherapy cycles (median 6 in both cohorts), receipt of immunotherapy with first line chemotherapy (6.7% escalated vs 13.0% standard, P = 0.42), percentage with brain metastases at presentation (41.2% escalated vs 36.7% standard, P = 0.55), and receipt of prophylactic cranial irradiation (29.4% escalated vs 44.4% standard, P = 0.50). The were no significant differences between cohorts in OS (12 month 71% escalated vs 70% standard, P = 0.97) or PFS (12 month 35.3% escalated vs 29.6% standard, P = 0.64). There was no significant difference in the incidence of local failure between cohorts (12 month 14.1% escalated vs 25.6% standard, P = 0.86). The escalated cohort had higher rates of grade 2+ esophagitis (47.1% vs 16.7%, P = 0.01) and grade 2+ fatigue (29.1% vs 9.3%, P = 0.04). Conclusion In this retrospective study, consolidative thoracic RT doses higher than 30 Gy in 10 fractions did not significantly improve local recurrence or survival outcomes, and higher doses were associated with more acute toxicity. These data suggest that escalated doses do not provide an incremental benefit in disease outcomes and provide evidence for maintaining 30 Gy as the standard of care. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|