Timing of radiotherapy for limited-stage small cell lung cancer in the elderly
Wang Youyou, Xu Kunpeng, Xu Liming, Wang Jun, Pang Qingsong, Yuan Zhiyong, Zhao Lujun, Wang Ping
Department of Radiation Oncology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tian Jin; Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China
Abstract：Objective To investigate the effect of the timing of radiotherapy on the prognosis of limited-stage small cell lung cancer (LS-SCLC) in the elderly. Methods A retrospective analysis was performed on the clinical data of 80 elderly patients with LS-SCLC who were treated with radical sequential thoracic chemoradiotherapy from 2008 to 2014.The correlations of SER (time from the start of any treatment to the end of radiotherapy) and the number of induction chemotherapy cycles with overall survival (OS) and progression-free survival (PFS) rates was analyzed. The treatment outcomes were compared between early radiotherapy group (no later than 3 cycles of induction chemotherapy,n=37) and late radiotherapy group (after 3 cycles of induction chemotherapy,n=43).The Kaplan-Meier method was used for survival analysis. Results In all patients,the median OS and PFS were 23.5 and 13.3 months respectively. SER was significantly correlated with OS and PFS (P=0.001;P=0.001).The median OS in patients undergoing radiotherapy after 2,3,4,5,and 6 cycles of induction chemotherapy was 33.2,26.7,20.6,16.9,and 17.9 months (P=0.000),respectively. The median OS time and 1-,2-,and 5-year OS rates were 27.8 months,87%,62%,and 34%,respectively,in the early radiotherapy group,and 17.9 months,74%,37%,and 15%,respectively,in the late radiotherapy group (P=0.017).The median PFS time and 1-,2-,and 5-year PFS rates were 17.1 months,65%,43%,and 28%,respectively,in the early radiotherapy group,and 11.9months,49%,21%,and 14%,respectively,in the late radiotherapy group (P=0.022). Conclusions Shorter SER achieves better treatment outcomes in elderly patients with LS-SCLC undergoing sequential chemoradiotherapy. Early radiotherapy provides a survival benefit for patients.
Wang Youyou,Xu Kunpeng,Xu Liming et al. Timing of radiotherapy for limited-stage small cell lung cancer in the elderly[J]. Chinese Journal of Radiation Oncology, 2018, 27(1): 49-52.
[1] Govindan R,Page N,Morgensztern D,et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years:analysis of the surveillance,epidemiologic,and end results database[J].J Clin Oncol,2006,24(28):4539-4544.DOI:10.1200/Jco.2005.04.4859 [2] 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].J Clin Oncol,2002,20(14):3054-3060.DOI:10.1200/Jco.2002.12.071 [3] Fried DB,Morris DE,Poole C,et al. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer[J].J Clin Oncol,2004,22(23):4837-4845.DOI:10.1200/Jco.2004.01.178 [4] De Ruysscher D,Pijls-Johannesma M,Bentzen SM,et al. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer[J].J Clin Oncol,2006,24(7):1057-1063.DOI:10.1200/JCO.2005.02.9793 [5] Sekine I,Yamamoto N,Kunitoh H,et al. Treatment of small cell lung cancer in the elderly based on a critical literature review of clinical trials[J].Cancer Treat Rev,2004,30(4):359-368.DOI:10.1016/j.ctrv.2003.12.006 [6] Hutchins LF,Unger JM,Crowley JJ,et al. Underrepresentation of patients 65 years of age or older in cancer-treatment trials[J].New Engl J Med,1999,341(27):2061-2067.DOI:10.1056/NEJM199912303412706 [7] Gridelli C,Perrone F,Gallo C,et al. Chemotherapy for elderly patients with advanced non-small-cell lung cancer:the multicenter Italian lung cancer in the elderly study (MILES) phase Ⅲ randomized trial[J].J Nat Cancer Inst,2003,95(5):362-372 [8] 王鹏,刘维帅,徐利明,等.老年局限期小细胞肺癌应慎用同期放化疗[J].中华放射肿瘤学杂志,2015,24(3):237-240.DOI:10.3760/cma.j.issn.1004-4221.2015.03.003.Wang P,Liu WS,Xu LM,et al. Concurrent chemoradiotherapy should be used with caution in elderly patients[J].Chin J Radiat Oncol,2015,24(3):237-240.DOI:10.3760/cma.j.issn.1004-4221.2015.03.003 [9] Owonikoko TK,Ragin CC,Belani CP,et al. Lung cancer in elderly patients:an analysis of the surveillance,epidemiology,and end results database[J].J Clin Oncol,2007,25(35):5570-5577.DOI:10.1200/Jco.2007.12.5435 [10] Bogart JA,Gajra A.Limited-stage small-cell lung cancer:an age limit for combined modality therapy?[J].J Clin Oncol,2015,33(36):4235-4237.DOI:10.1200/JCO.2015.64.0888 [11] Corso CD,Rutter CE,Park HS,et al. Role of chemoradiotherapy in elderly patients with limited-stage small-cell lung cancer[J].J Clin Oncol,2015,33(36):4240-4246.DOI:10.1200/Jco.2015.62.4270 [12] Shukuya T,Takahashi T,Harada H,et al. Chemoradiotherapy for limited-disease small-cell lung cancer in elderly patients aged 75 years or older[J].Jpn J Clin Oncol,2013,43(2):176-183.DOI:10.1093/jjco/hys197 [13] Sas-Korczynska B,Sokolowski A,Korzeniowski S.The influence of time of radio-chemotherapy and other therapeutic factors on treatment results in patients with limited disease small cell lung cancer[J].Lung Cancer,2013,79(1):14-19.DOI:10.1016/j.lungcan.2012.10
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