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Fang Peng



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    MA12 - Controversies Old and New (ID 230)

    • Event: WCLC 2020
    • Type: Mini Oral
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
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      MA12.06 - A Study of the Prognosis of Patients With Limited-Stage SCLC Who Did Not Receive Prophylactic Cranial Irradiation After Chemoradiotherapy (ID 957)

      16:45 - 17:45  |  Author(s): Fang Peng

      • Abstract
      • Slides

      Introduction

      To evaluate the prognosis of small cell lung cancer (SCLC) patients who did not receive prophylactic cranial irradiation (PCI) after effective initial standard thoracic radiotherapy and chemotherapy.

      Methods

      Patients with limited-stage SCLC accrued in a prospective study were retrospectively analyzed. Those who had achieved complete remission (CR) or partial remission (PR) after radio-chemotherapy but did not receive PCI were selected. Kaplan Meier method was used to calculate survival data. The prognosis was analyzed using Cox proportional hazard regression model.

      Results

      Among 309 patients enrolled between June 2002 and January 2017, 275 patients achieved CR or PR after thoracic radiotherapy and chemotherapy, 82 patients did not receive PCI, 46 of them developed brain metastasis were analyzed in this study. The median time between brain metastasis and initial treatment was 5.5 months (2.9-26.6) and the median time between brain metastasis and the end of radiotherapy and chemotherapy was 1.7 months (0.2-24.0). Thirteen patients (28.3%) detected brain metastases before PCI, 24 patients (52.2%) had multiple brain metastases (≥ 3), 18 patients (39.1%) had symptomatic brain metastases, and 21 patients (45.7%) had control / slow progress of extracranial diseases. Thirty-three patients had complete treatment data for brain metastasis. Among them, 19 patients (57.6%) received brain radiotherapy alone, 4 patients (12.1%) received chemotherapy alone, 6 patients (18.2%) received brain radiotherapy and chemotherapy, and 4 patients (12.1%) did not receive treatment. The median survival time after brain metastasis was 7.0 months (95% CI: 4.6-9.3), and the overall survival rates of 1 year and 3 years were 32.6% and 3.3%, respectively. The median survival time of patients who received radiotherapy alone, chemotherapy alone and combined therapy were 8.3 months (4.7-11.8), 3.2 months (0.0-8.5), and 30.5 months (0.0-78.1) respectively (P = 0.000). Multivariate analysis showed that multiple brain metastases was a negative prognostic factors (HR: 3.59, 95% CI: 1.37-9.36, P = 0.009), brain radiotherapy (HR: 0.09, 95% CI: 0.02-0.37, P = 0.001), systemic chemotherapy (HR: 0.11, 95% CI: 0.02-0.61, P = 0.01) were favorably associated with overall survival.

      Conclusion

      Patients with SCLC who did not receive PCI tended to develop brain metastasis and had poor prognosis. PCI is highly recommended in patients who achieved CR and PR after thoracic radiotherapy and chemotherapy. Brain radiotherapy combined with chemotherapy could improve survival for patients with brain metastasis.

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    P49 - Small Cell Lung Cancer/NET - Radiotherapy (ID 237)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P49.02 - Simultaneous Integrated Boost IMRT(54 Gy)versus Conventional IMRT(45 Gy)Twice Daily Combined With Chemotherapy for LS-SCLC (ID 1211)

      00:00 - 00:00  |  Presenting Author(s): Fang Peng

      • Abstract
      • Slides

      Introduction

      Twice-daily thoracic radiotherapy (TRT) with concurrent chemotherapy is standard for limited-stage small-cell lung cancer (LS-SCLC). However, the importance of twice-daily simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) has not been clearly defined in LS-SCLC. Therefore, we compared SIB-IMRT for dose escalation (54 Gy) to the gross tumor volume versus conventional intensity-modulated radiotherapy (IMRT) of standard-dose(45 Gy)twice-daily combined with concurrent chemotherapy in patients with LS-SCLC.

      Methods

      We previously conducted a prospective study on thoracic radiotherapy target volumes for LS-SCLC (Cancer, 2020, 126(4), 840-849). In that study, From 2012-2017, 85 patients received IMRT to the postchemotherapy tumor volume, as the IMRT group in this retrospective analysis. In the IMRT group, the prescribed dose was 45 Gy at 1.5 Gy per twice-daily fraction to both the planning gross tumor volume (PGTV) and the planning clinical tumor volume (PCTV). From 2015-2019, 40 patients with LS-SCLC were treated with SIB-IMRT to the postchemotherapy tumor volume, as the SIB-IMRT group. In the SIB-IMRT group, the prescribed dose was 54Gy at 1.8Gy twice daily to PGTV , and 45Gy at 1.5Gy twice daily to PCTV. All of the 125 patients received concurrent chemoradiotherapy after completion of 2 cycles of induction cisplatin-etoposide chemotherapy, and received chemotherapy for 4 to 6 cycles in total. We compared progression free survival (PFS) and overall survival (OS) between the treatment groups by using the Kaplan-Meier method and Cox proportional hazards regression before and after propensity score matching (PSM).

      Results

      Overall, with a median follow-up of 19.4 months, the median PFS and OS were 12.9 and 23.1 months, respectively. The patients in the SIB-IMRT group showed longer PFS than those in the IMRT group (median PFS not reached versus 11.5 months; p = 0.003). The median OS of the SIB-IMRT and IMRT groups were 35.0 and 20.3 months, with the 2-year OS rate of 73.5% and 38.8%, respectively ( p =0.018 ). After matching by PSM, (35 cases for each group), the median PFS and OS was not reached and 35.0 months, respectively, in the SIB-IMRT group, which was longer than the IMRT group (PFS 8.0 months, p = 0.001, and OS 19.0 months, p = 0.011) (fig 1). For radiotherapy toxicity, grade 2 acute esophagitis was more common in the SIB-IMRT group, but grade≥3 esophagitis and grade≥2 pneumonitis was no difference in both two groups.fig 1.jpg

      Conclusion

      For LS-SCLC patients, SIB-IMRT for dose escalation (54 Gy at 1.8Gy twice daily) to PGTV benefited survival greatly. Our results suggest that SIR-IMRT is safe and effective for patients with LS-SCLC and should be further evaluated in a large prospective clinical trial.

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    P50 - Small Cell Lung Cancer/NET - Real World Outcomes (ID 232)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P50.06 - How much Platinum-Based Chemotherapy is Enough in Limited-Stage SCLC: A Propensity Score-Matched Analysis of a Prospective Trial (ID 2297)

      00:00 - 00:00  |  Presenting Author(s): Fang Peng

      • Abstract
      • Slides

      Introduction

      Etoposide and platinum-based chemotherapy combined with thoracic radiotherapy (TRT) is the standard first-line treatment for patients with limited-stage small-cell lung cancer (LS-SCLC). However, the optimal total number of chemotherapy cycles has been unclear. Our aims were to investigate the outcome and toxicity of 6 versus 4-5 cycles of etoposide and cisplatin (EP) in patients with LS-SCLC who received 4 to 6 cycles of EP regimen chemotherapy and concurrent TRT.

      Methods

      We previously conducted a prospective study on TRT target volumes for LS-SCLC (ClinicalTrials.gov, number NCT01731548). Based on the patient data from our previous prospective randomized trial, this retrospective analysis evaluated 265 patients with LS-SCLC who received 4-6 cycles of EP regimen chemotherapy and concurrent twice daily hyperfractionated thoracic radiotherapy as the first-line treatment between June 2002 and January 2017. Patients were divided into two groups depending on number of chemotherapy cycles (6 versus 4-5 cycles). We compared progression free survival (PFS) and overall survival (OS) between the treatment groups by using the Kaplan-Meier method and Cox proportional hazards regression after propensity score matching (PSM).

      Results

      Among the 265 patients, 60 (22.6%) patients received the 6 cycles of EP, and 205 (77.4%) received the 4-5 cycles of EP. After matching by PSM, (57 cases for each group), PFS was significantly better for patients in the 6 cycles group compared to that for patients in the 4-5 cycles group (median PFS: 19.4 vs 12.5 months, respectively, p =0.019). The median OS of the 6 cycles group and 4-5 cycles group was 25.4 and 30.5 months (p = 0.161). The 2- and 3-year OS rates were 61.4% and 43.9% in the 6 cycles group, while 52.6% and 28.1% in the 4-5 cycles group, respectively (Fig 1).fig 1.jpg

      Conclusion

      Compared to 4-5 cycles, 6 cycles of standard chemotherapy resulted in significantly improved PFS and numerically longer median OS in LS-SCLC patients who received etoposide and platinum-based chemotherapy combined with thoracic radiotherapy. A prospective study directly comparing 6 vs 4 or 5 cycles would be required to prove a survival benefit of etoposide and platinum-based chemotherapy continuation in the era of modern radiotherapy techniques and supportive care.

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