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J.V. Heymach

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    MO13 - SCLC I (ID 118)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO13.03 - Duration of Thoracic Radiotherapy with Concurrent Chemotherapy is Important for Outcome of Patients with Limited-Stage Small Cell Lung Cancer (L-SCLC) (ID 2834)

      10:30 - 12:00  |  Author(s): J.V. Heymach

      • Abstract
      • Presentation
      • Slides

      A previous Intergroup study of L-SCLC showed that accelerated hyperfractionated thoracic radiotherapy (TRT) given over 3 weeks with concurrent etoposide and cisplatin (EP) led to improved 5-year survival rates compared with daily TRT given over 5 weeks, albeit with higher rates of grade 3 acute esophagitis. We retrospectively compared the efficacy and toxicity of TRT with concurrent EP for L-SCLC given in <6 weeks (Group A) versus >6 weeks (Group B).

      A total of 577 patients with cytotogically or histologically biopsy proven L-SCLC (staged by chest/upper abdominal CT and brain MRI) received TRT+EP at a single institution in 1985‒2009. Group A received 45 Gy in 30 fractions over 3 weeks (BED=52) or 28 fractions over 5 weeks (BED=43) or 61.2 Gy in 34 fractions over 5 weeks (BED=72). Group B received a median 60 Gy in 6 weeks (BED=72). Cone-down fields were used routinely. Complete responders received prophylactic cranial irradiation (PCI). Kaplan-Meier analysis was used to estimate survival, with log-rank tests used to compare survival curves; p values ≤0.05 were taken to indicate signifiance. Cox regression analysis was used for univariate and multivariate analyses and toxicity was graded according to CTCAE v2.0.

      The median follow-up time for patients alive at the time of analysis was 32 months (range 1.2‒222 months); median age was 62 years (range 27–95); and 87% had Karnofsky Performance Status (KPS) scores of ≥80. Group A contained 503 patients and group B had 74. The groups did not differ in KPS, age, smoking history, or receipt of PCI. Group A was more likely to have received concurrent chemoTRT than sequential chemoTRT (p<0.001). At 5 years, the overall survival (OS) rates were 26.1% for group A vs. 14.1% for group B (p=0.077); disease free-survival (DFS) rates were 31.6% (group A) vs. 13.5% (group B) (p=0.008); local-regional control (LRC) rates were 55.1% (A) vs. 36.2% (B) (p=0.077); and distant metastasis-free survival (DMFS) rates were 40.8% (A) vs. 20.0% (B) (p=0.008). No differences were found in rates of grade ≥3 acute esophagitis (17% group A vs.18% group B) or pneumonitis (4% group A vs. 3% group B). Group B had a higher rate of grade ≥3 lung fibrosis (10% group A vs. 22% group B, p=0.01). Multivariate analysis showed that factors influencing worse DFS were receiving TRT in more than 6 weeks (HR=1.46, p=0.008) and receipt of sequential rather than concurrent chemoTRT (HR=1.51, p=0.001); age <62 years (HR=0.99, p< 0.039) and receipt of PCI (HR=0.77, p=0.015) were associated with better DFS.

      TRT given with concurrent EP over periods longer than 6 weeks led to lower rates of DFS, worse local and distant disease control, and higher rates of severe lung fibrosis. Factors associated with better DFS were younger age, concurrent chemoTRT, and use of PCI. Rates of acute grade ≥3 esophagitis and pneumonitis were low in both groups. Final recommendations await the results of an ongoing prospective randomized trial.

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