Impact of the number of chemotherapy cycle of concurrent chemotherapy during radiotherapy on clinical prognosis of limited-stage small cell lung cancer
Ge Xingping1, Yu Hao2, Zhang Jiaqi2, Zhang Zhen2, Wang Youyou3, Wang Peng4, Xu Liming2, Liu Ningbo2, Zhao Lujun2
1Department of Radiotherapy, Yantaishan Hospital, Yantai 264003, China; 2Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key laboratory of Cancer Prevention and Therapy, Tianjin′s Clinical Research Center for Cancer, Tianjin 300060, China; 3Tianjin First Central Hospital, Tianjin 300192, China; 4Peking University International Hospital, Beijing 102206, China
Abstract：Objective To investigate the role of concurrent chemoradiotherapy in the treatment of limited-stage small cell lung cancer (LS-SCLC) and the impact of the number of chemotherapy cycle during radiotherapy (RT) on clinical prognosis. Methods Patients with LS-SCLC treated with definitive radiotherapy from May, 2008 to September, 2016 were included in the study. The primary endpoint was overall survival (OS), which was calculated from the start of treatment to the date of death or last follow-up. The effect of the number of concurrent chemotherapy cycle and other clinical factors on clinical efficacy was analyzed. Survival analysis was performed with Kaplan-Meier method, and multivariate analysis was performed with Cox regression model. Results Three hundred and seventeen patients were eligible for the analysis. Among them, 129 patients received sequential chemoradiotherapy and 188 patients received concurrent chemoradiotherapy. Among patients receiving concurrent chemoradiotherapy, 86 patients received 1 cycle of concurrent chemotherapy and 102 cases of 2 cycles of concurrent chemotherapy. The median follow-up time was 22.47 months. Multivariate survival analysis showed that only clinical stage, timing of RT administration and prophylactic cranial irradiation (PCI) were the independent prognostic factor for OS. The median OS in patients who received 1 cycle and 2 cycles of concurrent chemotherapy during RT were 33.8 months and 30.4 months (P=0.400). No matter in elder patients or in younger patients, in early RT group or in late RT group and application of PCI or not, the number of concurrent chemotherapy cycle exerted no significant impact on OS. The incidence of grade 3 or above adverse events was 20% in the 1-cycle concurrent chemotherapy group, and 13.7% in the 2-cycle concurrent chemotherapy group. Conclusions Concurrent chemoradiotherapy is the standard treatment of LS-SCLC. Two cycles of concurrent chemotherapy during RT is not necessarily superior to 1 cycle of concurrent chemotherapy. The optimal number of concurrent chemotherapy cycle during RT need to be studied in a large prospective randomized clinical trial.
Ge Xingping,Yu Hao,Zhang Jiaqi et al. Impact of the number of chemotherapy cycle of concurrent chemotherapy during radiotherapy on clinical prognosis of limited-stage small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(7): 671-675.
[1] 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.
[2] Wei X, Allen PK, Welsh JW, et al. Immediately concurrent chemoradiation therapy is associated with improved 2-year overall survival in patients with limited small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2016, 96:E454-E455.
[3] 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.
[4] Stinchcombe TE, Fan W, Schild SE, et al. A pooled analysis of individual patient data from National Clinical Trials Network clinical trials of concurrent chemoradiotherapy for limited-stage small cell lung cancer in elderly patients versus younger patients[J]. Cancer, 2019, 125(3):382-390. DOI:10.1002/cncr.31813.
[5] Christodoulou M, Blackhall F, Mistry H, et al. Compliance and outcome of elderly patients treated in the concurrent once-daily versus twice-daily radiotherapy (CONVERT) trial[J]. J Thorac Oncol, 2019, 14(1):63-71. DOI:10.1016/j.jtho.2018.09.027.
[6] 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.
[7] 王优优,许昆鹏,徐利明,等. 老年局限期SCLC放疗时机选择探讨[J]. 中华放射肿瘤学杂志,2018, 27(1):49-52. DOI:10.3760/cma.j.issn.1004-4221.2018.01.010.
Wang YY, Xu KP, Xu LM, et al. Timing of radiotherapy for limited-stage small cell lung cancer in the elderly[J]. Chin J Radiat Oncol, 2018, 27(1):49-52. DOI:10.3760/cma.j.issn.1004-4221.2018.01.010.
[8] Hasan S, White R, Renz P, et al. Optimal timing of thoracic radiotherapy in limited stage small cell lung cancer (SCLC) with daily fractionation:A brief report[J]. Radiother Oncol, 2019, 132(1):23-26. DOI:10.1016/j.radonc.2018.11.005.
[9] Hu X, Xia B, Bao Y, et al. Timing of thoracic radiotherapy is more important than dose intensification in patients with limited-stage small cell lung cancer:a parallel comparison of two prospective studies[J]. Strahlenther Onkol, 2020, 196(2):172-181. DOI:10.1007/s00066-019-01539-1.
[10] Jeong JU, Jeon W, Ahn SJ, et al. Treatment time to the end of thoracic radiotherapy has more predictive power for survival than radiation dose intensity in patients with limited-stage small-cell lung cancer receiving concurrent chemoradiation of more than 45Gy[J]. Oncol Lett, 2020, 19(1):239-246. DOI:10.3892/ol.2019.11107.
[11] Wang P, Liu W, Zhao L, et al. Does the response to induction chemotherapy impact the timing of thoracic radiotherapy for limited-stage small-cell lung cancer?[J]. Thorac Cancer, 2015, 6(5):605-612. DOI:10.1111/1759-7714.12229.
2021, Vol. 30 
