Effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on prognosis of limited-stage small-cell lung cancer
Hu Xiao,Xia Bing,Bao Yong,Xu Yujin,Wang Jin,Ma Honglian,Jin Ying,Fang Min,Tang Huarong,Chen Mengyuan,Dong Baiqiang,Fu Xiaolong,Chen Ming
Department of Radiation Oncology,Zhejiang Cancer Hospital,Zhejiang Provincial Key Laboratory of Radiation Oncology,Hangzhou 310022,China (Hu X,Xu YJ,Wang GJ,Ma HL,Fang M,Tang HR,Chen MY,Dong BQ,Chen M);Department of Radiation Oncology,Hangzhou Cancer Hospital,Department of Radiation Oncology,Cancer Hospital of Fudan University (Xia B);Department of Radiation Oncology,Cancer Center of Sun Yat-sen University,Guangzhou 510060,China (Bao Y);Department of Radiation Oncology,Chest Hospital of Shanghai JiaoTong University,Cancer Hospital of Fudan University,Shanghai 200030,China (Fu XL)Hu Xiao and Xia Bing contributed equally to this study
Abstract：Objective To investigate the effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on the prognosis of limited-stage small-cell lung cancer (SCLC). Methods A total of 188 patients with limited-stage SCLC were enrolled in this study and divided into hyperfractionated group (n=92) and hypofractionated group (n=96). The hyperfractionated group received thoracic radiotherapy at 45 Gy in 30 fractions twice a day, while the hypofractionated group received 55 Gy in 22 fractions once a day. The Kaplan-Meier method was used to calculate survival rates, and the Cox model was used for multivariate prognostic analysis. Results There were not significant differences in 1-, 2-, and 5-year progression-free survival (PFS) rates and 1-, 2-, and 5-year overall survival (OS) rates between the hyperfractionated group and the hypofractionated group (82% vs. 85%, 61% vs. 69%, 59% vs. 69%, P=0.27;85% vs. 77%, 41% vs. 34%, 27% vs. 27%, P=0.37). The multivariate analysis showed that the time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days was favorable prognostic factor for PFS (P=0.005). The time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days and prophylactic cranial irradiation were favorable prognostic factors for OS (P=0.044;P=0.000). There were significant differences in incidence rates of grade 2 and 3 acute radiation esophagitis between the two groups (28% vs. 16%, 9% vs. 2%, P=0.009). Conclusions Both hyperfractionated radiotherapy and hypofractionated radiotherapy combined with chemotherapy can improve the PFS and OS of patients with limited-stage SCLC. The time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days and the time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days are favorable prognostic factors for PFS and OS, respectively. However, the hyperfractionated group has significantly higher incidence rates of grade 2 and 3 acute radiation esophagitis than the hypofractionated group.
Hu Xiao,Xia Bing,Bao Yong et al. Effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on prognosis of limited-stage small-cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(9): 1000-1005.
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