Final report of a prospective randomized study on thoracic radiotherapy target volumes for limited-stage small cell lung cancer
Hu Xiao, Bao Yong, Xu Yujin, Zhang Li, Wang Jin, Ma Honglian, Jin Ying, Xu Xiaoling, Song Zhengbo, Peng Fang, Tang Huarong, Fang Min, Kong Yue, Chen Mengyuan, Dong Baiqiang, Yu Xinmin, Lu Hongyang, Zhang Yiping, Fan Yun, Chen Ming
Department of Radiation Oncology (Hu X,Xu YJ,Wang GJ,Ma HL,Tang HR,Fang M,Kong Y,Chen MY,Dong BQ,Chen M),Department of Medical Oncology (Jin Y,Xu XL,Song ZB,Yu XM,Lu HY,Zhang YP,Fan Y),Zhejiang Cancer Hospital,Zhejiang Provincial Key Laboratory of Radiation Oncology,Hangzhou 310022,China; Department of Radiation Oncology,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510060,China (Bao Y,Peng F); Department of Medical Oncology,Cancer Center of Sun Yat-sen University,Guangzhou 510060,China (Zhang L)
Abstract：Objective In view of the controversy over radiotherapy target volume for patients with limited-stage small cell lung cancer (SCLC),a prospective randomized controlled trial was conducted to compare the impact of different radiotherapy target volumes on prognosis. Methods After 2 cycles of EP chemotherapy,patients without progressive disease were randomly assigned to receive thoracic radiotherapy (TRT) to either the post-or pre-chemotherapy primary tumour extent as study arm or control. Involved field radiotherapy (IFRT) to the entire metastatic lymph node regions was applied for both arms. TRT consisted of 45 Gy/30Fx/19 d administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients achieved complete or partial remission. Kaplan-Meier method was used for survival analysis. Results Between June 2002 and December 2017,159 and 150 patients were randomly assigned to study arm and control respectively. The 1-,2-,and 5-year local/regional control rates were 79.4%,61.5% and 60.1% respectively in the study arm versus 79.8%,66.5%,and 57.3% in the control arm (P=0.73).The median OS time was 22.1 months in the study arm (95%CI,18.2-26.0 months) and 26.9 months (95%CI,23.5-30.3 months) in the control arm,the 1-,3-,5-,and 7-year OS rates were 81.1%,31.6%,23.9% and 22.2% respectively in the study arm versus 85.3%,36.6%,26.1% and 20.0% in the control arm (P=0.51).Grade 2-3 acute esophagitis was developed in 32.9% and 43.2% of patients respectively in study arm and control arm (P=0.01),while grade 2-3 pulmonary fibrosis was observed in 2.0% and 10.9% of patients (P=0.01) respectively. Conclusions For patients with limited-stage SCLC who received induction chemotherapy,thoracic radiotherapy can be limited to post-chemotherapy tumour extent and IFRT can be routinely applied.
Hu Xiao,Bao Yong,Xu Yujin et al. Final report of a prospective randomized study on thoracic radiotherapy target volumes for limited-stage small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(12): 1046-1050.
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