Clinical efficacy and prognostic factors of intensity-modulated radiotherapy combined with chemotherapy for limited-stage small cell lung cancer
Liu Xuan, Zhou Zongmei, Wang Yuxia, Dong Xin, Chen Dongfu, Xiao Zefen, Feng Qinfu, Lyu Jima, Liang Jun, Wang Xiaozhen, Hui Zhouguang, Wang Lyuhua, Li Yexiong, Yin Weibo
Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100021,China
Abstract：Objective To investigate the clinical efficacy and prognosis of intensity-modulated radiotherapy (IMRT) combined with chemotherapy for limited-stage small cell lung cancer (LS-SCLC). Methods A retrospective analysis was performed on the clinical data of 484 LS-SCLC patients treated with chemoradiotherapy in our center from 2006 to 2014. The patients with partial or complete response to IMRT received prophylactic cranial irradiation (PCI). The Kaplan-Meier method was used to calculate survival rates, and the log-rank test and Cox regression were used for univariate and multivariate analyses, respectively. Results In all the patients, the follow-up rate was 93%;the median overall survival (OS) time was 23.8 months;the 2-, 3-, and 5-year OS rates were 48.7%, 39.8%, and 28.6%, respectively;the median progression-free survival (PFS) time was 14.1 months;the 2-, 3-, and 5-year PFS rates were 34.4%, 30.5%, and 28.3%, respectively. The incidence rates of grade ≥3 bone marrow suppression, grade ≥2 radiation esophagitis, and grade ≥2 radiation pneumonitis were 26.9%, 24.8%, and 18.4%, respectively, in SCLC patients after IMRT. The objective response rate was 84.5%. The univariate analysis showed that age, smoking history, TNM stage, PCI, and the number of chemotherapy cycles before radiotherapy were prognostic factors for OS (P=0.006, 0.001, 0.047, 0.000, and 0.046). The multivariate analysis showed that smoking history and PCI were independent prognostic factors (P=0.001 and 0.000). Conclusions IMRT combined with chemotherapy achieves satisfactory clinical outcomes in the treatment of LS-SCLC. Smoking history and PCI are independent prognostic factors for OS of LS-SCLC patients.
Liu Xuan,Zhou Zongmei,Wang Yuxia et al. Clinical efficacy and prognostic factors of intensity-modulated radiotherapy combined with chemotherapy for limited-stage small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(3): 256-260.
[1] van Meerbeeck JP,Fennell DA,De Ruysscher DK.Small-cell lung cancer[J].Lancet,2011,378(9804):1741-1755.DOI:10.1016/S0140-6736(11)60165-7. [2] Murray N,Coy P,Pater JL,et al. Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group[J].J Clin Oncol,1993,11(2):336-344.DOI:10.1200/JCO.1993.11.2.336. [3] Jeremic B,Shibamoto Y,Acimovic L,et al. Initial versus delayed accelerated hyperfractionated radiation therapy and concurrent chemotherapy in limited small-cell lung cancer:a randomized study[J].J Clin Oncol,1997,15(3):893-900.DOI:10.1200/JCO.1997.15.3.893. [4] 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[J].N Engl J Med,1999,340(4):265-271.DOI:10.1056/NEJM199901283400403. [5] 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. [6] Hu X,Bao Y,Zhang L,et al. Omitting elective nodal irradiation and irradiating postinduction versus preinduction chemotherapy tumor extent for limited-stage small cell lung cancer:interim analysis of a prospective randomized noninferiority trial[J].Cancer,2012,118(1):278-287.DOI:10.1002/cncr.26119. [7] Sun JM,Ahn YC,Choi EK,et al. Phase Ⅲ trial of concurrent thoracic radiotherapy with either first-or third-cycle chemotherapy for limited-disease small-cell lung cancer[J].Ann Oncol,2013,24(8):2088-2092.DOI:10.1093/annonc/mdt140. [8] Faivre-Finn C,Snee M,Ashcroft L,et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT):an open-label,phase 3,randomised,superiority trial[J].Lancet Oncol,2017,18(8):1116-1125.DOI:10.1016/S1470-2045(17)30318-2. [9] Pesch B,Kendzia B,Gustavsson P,et al. Cigarette smoking and lung cancer—relative risk estimates for the major histological types from a pooled analysis of case-control studies[J].Int J Cancer,2012,131(5):1210-1219.DOI:10.1002/ijc.27339. [10] Wolf M,Holle R,Hans K,et al. Analysis of prognostic factors in 766 patients with small cell lung cancer (SCLC):the role of sex as a predictor for survival[J].Br J Cancer,1991,63(6):986-992. [11] Ou SH,Ziogas A,Zell JA.Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC):the importance of smoking history,socioeconomic and marital statuses,and ethnicity[J].J Thorac Oncol,2009,4(1):37-43.DOI:10.1097/JTO.0b013e31819140fb. [12] 张文珏,朱慧,周宗玫,等.局限期小细胞肺癌放化疗综合治疗的疗效和预后影响因素分析[J].中华放射肿瘤学杂志,2015,37(3):223-226.DOI:10.3760/cma.j.issn.0253-3766.2015.03.015. Zhang WJ,Zhu H,Zhou ZM,et al. Clinical outcomes and prognostic factors in limited-stage small cell lung cancer:a single institution experience[J].Chin J Radiat Oncol,2015,37(3):223-226.DOI:10.3760/cma.j.issn.0253-3766.2015.03.015. [13] Paesmans M,Sculier JP,Lecomte J,et al. Prognostic factors for patients with small cell lung carcinoma:analysis of a series of 763 patients included in 4 consecutive prospective trials with a minimum follow-up of 5 years[J].Cancer,2000,89(3):523-533. [14] Ludbrook JJ,Truong PT,MacNeil MV,et al. Do age and comorbidity impact treatment allocation and outcomes in limited stage small-cell lung cancer? a community-based population analysis[J].Int J Radiat Oncol Biol Phys,2003,55(5):1321-1330. [15] 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. [16] 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. [17] Aupérin A,Arriagada R,Pignon JP,et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group[J].N Engl J Med,1999,341(7):476-484.DOI:10.1056/NEJM199908123410703. [18] Arriagada R,Le Chevalier T,Riviere A,et al. Patterns of failure after prophylactic cranial irradiation in small-cell lung cancer:analysis of 505 randomized patients[J].Ann Oncol,2002,13(5):748-754.
2018, Vol. 27 
