Consolidation radiotherapy for patients with extended disease small cell lung cancer in a single tertiary institution: impact of dose and perspectives in the era of immunotherapy
, and | Jul 29, 2020
About this article
Article Category: Research Article
Published Online: Jul 29, 2020
Page range: 353 - 363
Received: Mar 09, 2020
Accepted: Jul 04, 2020
DOI: https://doi.org/10.2478/raon-2020-0046
© 2020 Karmen Stanic, Martina Vrankar, Jasna But-Hadzic, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1
Figure 2
Figure 3
Univariate and multivariate analysis of overall survival for patients with cRT vs no cRT (n = 187)
| p | Univariate analysis | p | Multivariate analysis | |
|---|---|---|---|---|
| HR (95% CI) | HR (95% CI) | |||
| no | ||||
| yes | ||||
| 0.68 | 1.03 (0.87–1.21) | |||
| Male | ||||
| Female | ||||
| 0.25 | 1.19 (0.88–1.62) | |||
| > 65 | ||||
| < 65 | ||||
| < 4 | ||||
| > 4 | ||||
| 0.98 | 1.00 (0.67–1.50) | |||
| T1, 2 | ||||
| T3, 4 | ||||
| 0.16 | 1.08 (0.96–1.22) | |||
| N0-2 | ||||
| N3 | ||||
| Brain no/yes | 0.61 | 0.91 (0.64–1.29) | ||
| Liver no/yes | 0.40 | 1.13 (0.84–1.52) | ||
| Bone no/yes | 0.75 | 0.94 (0.67-1.33) | ||
| Adrenal no/yes gland | 0.62 | 1.09 (0.76–1.57) | ||
| Other no/yes | 0.18 | 1.21 (0.90–1.63) | ||
| 0.68 | 1.06 (0.79–1.42) | |||
| 1 | ||||
| > 2 | ||||
| No | ||||
| Yes |
Patients’ characteristics: higher vs. lower dose of radiotherapy
| All | 45 Gy | 30-36 Gy | p | |
|---|---|---|---|---|
| n (%) | n (%) | n (%) | ||
| 59 | 15 | 44 | ||
| Male | 35 (60) | 6 (40) | 29 (65.9) | 0.078 |
| Female | 24 (40) | 9 (60) | 15 (34.1) | |
| median | 62 (42–76) | 60 (54–73) | 62 (42–76) | 0.12 |
| < 65 | 42 (71.2) | 13 (68.7) | 29 ( 65.9) | |
| > 65 | 17 (28.8) | 2 (13.3) | 15 (34.1) | |
| < 4 | 12 (20.3) | 2 (13.3) | 10 (22.7) | 0.37 |
| > 4 | 44 (74.6) | 13 (68.7) | 31 (70.5) | |
| unknown | 3 (5.1) | 0 (0) | 3 (6.8) | |
| 0.66 | ||||
| 0-1 | 22 (37.3) | 5 (33.3) | 17 (38.6) | |
| 2–3 | 7 (11.8)) | 1 (6.67) | 6 (13.6) | |
| unknown | 30 (50.9) | 9 (0.6) | 21 (47.8) | |
| 0.15 | ||||
| T1–2 | 8 (13.6) | 4 (26.7) | 4 (9.1) | |
| T3–4 | 42 (71.2) | 8 (53.3) | 34 (77.3) | |
| Tx | 9 (15.3) | 3 (20) | 6 (13.6) | |
| 0.69 | ||||
| N0–2 | 24 (40.7) | 7 (46.7) | 17 (38.6) | |
| N3 | 29 (49.2) | 6 (40) | 23 (52.3) | |
| Nx | 6 (10.1) | 2 (13.3) | 4 (9.1) | |
| Brain | 14 (23.7) | 5 (33.3) | 9 (20.5) | 0.31 |
| Liver | 27 (45.7) | 6 (40) | 21 (47.7) | 0.60 |
| Bone | 13 (22) | 3 (30) | 10 ( 22.7) | 0.82 |
| Adrenal gland | 15 (25.4) | 3 (30) | 12 (27.3) | 0.57 |
| Other | 21 (35.6) | 3 (30) | 19 (43.2) | 0.10 |
| 1 | 34 (57.6) | 10 (66.7) | 24 (54.5) | 0.41 |
| > 2 | 25 (42.4) | 5 (33.3) | 20 (45.4) | |
| 0.15 | ||||
| < 4 weeks after ChT | 17 (53.1) | 6 (75) | 11 (45.9) | |
| > 4 weeks after ChT | 15 (46.9) | 2 (25) | 13 (54.1) | |
| Yes | 17 (28.8) | 5 (33.3) | 12 (27.3) | 0.65 |
Trials of consolidation radiotherapy (cRT) in extended disease small cell lung cancer (ED-SCLC)
| Author/Trial, reference | Publication year | Type of study | Patients -years enrolled | Number of patients | Patient selection | Thoracic irradiation dose scheme | mOS | 1-year OS | 2-year OS |
|---|---|---|---|---|---|---|---|---|---|
| Jeremic | 1999 | P | 1988–1993 | 109 | ED-SCLC with CR at metastatic sites and at least PR in thorax | 54 Gy in 36 fractions, BID | 17 m | 65% | 38% |
| Slotman (CREST) | 2015 | P | 2009–2012 | 495 | ED-SCLC with any response to ChT | 30 Gy in 10 fractions | 8 m | 33% | 13% |
| Gore (RTOG 0937) | 2017 | P | 2010–2016 | 97 | ED-SCLC (1-4 extracranial m., any response to ChT | 40 Gy in 15 fractions | 15.8 m | 50.8% | NR |
| Zhu | 2011 | R | 2003–2006 | 119 | ED-SCLC | 40–60 Gy | 17 m P = | NR | 35% |
| Giuliani | 2011 | R | 2005–2009 | 19 | ED-SCLC with metastatic minimal disease | 36–45 Gy | 14 m | 58% | 14% |
| Yee | 2012 | R | 2008–2009 | 32 | ED-SCLC | 40 fractions Gy in 15 | 8.3 m | NR | NR |
| Zhan | 2018 | R | 2010–2012 | 6812 | ED-SCLC from SEER database | Different, not reported | 9 m | NR | NR |
| Stanic | 2020 | R | 2010–2014 | 187 | ED-SCLC | 30–45 Gy | 11.1 7.6 m m | 44% | 10% |
Patients’ characteristics: chemotherapy only vs. chemotherapy with consolidation radiotherapy
| ChT only | ChT with cRT | p | ||
|---|---|---|---|---|
| n (%) | n (%) | |||
| 187 (100) | 113 (60.4) | 74 (39.6) | ||
| Male | 126 (67.4) | 81 (71.1) | 45 (60.1) | 0.12 |
| Female | 61 (32.6) | 32 (28.9) | 29 (39.9) | |
| median (range) | 63 (42-80) | 61 (42-80) | 63 (47-80) | 0.24 |
| < 65 | 122 (65.2) | 70 (61.9) | 52 (70.3) | |
| > 65 | 65 (34.8) | 43 (38.1) | 22 (29.7) | |
| < 4 | 66 (35.3) | 51 (47.2) | 15 (20) | |
| > 4 | 113 (60.4) | 57 (52.8) | 56 (80) | |
| 0.23 | ||||
| T1–2 | 32 (17.1) | 20(17.7) | 12 (16.2) | |
| T3-4 | 122 (65.2) | 69 (61) | 53 (71.6) | |
| Tx | 33 (17.7) | 24 (21.3) | 9 (12.2) | |
| 0.56 | ||||
| N0–2 | 71 (38) | 40 (35.4) | 31(41.9) | |
| N3 | 91(48.7) | 56 (49.6) | 35 (47.3) | |
| Nx | 25 (13.3) | 17 (15) | 8 (10.8) | |
| Brain | 44 (23.5) | 28 (24.8) | 16 (21.6) | 0.61 |
| Liver | 86 (46) | 57 (50.4) | 29 (39.2) | 0.13 |
| Bone | 42 (22.5) | 28 (24.8) | 14 (18.9) | 0.34 |
| Adrenal gland | 38 (20.3) | 23 (20.4) | 15 (20.3) | 0.98 |
| Other | 92 (49.2) | 62 (54.9) | 30 (40.5) | 0.06 |
| 1 | 105 (56.1) | 55 (48.7) | 50 (67.6) | |
| > 2 | 82 (43.9) | 58 (51.3) | 24 (23.4) | |
| Yes | 41 (21.9) | 20 (17.6) | 21 (28.4) | 0.08 |
| no | 146 (78.1) | 93 (82.4) | 53 (71.6) | |
Univariate and multivariate analysis of overall survival for higher vs. lower dose of consolidation radiotherapy
| p | Univariate analysis | p | Multivariate analysis | |
|---|---|---|---|---|
| HR (95% CI) | HR (95% CI) | |||
| 45 Gy | ||||
| 30-36 Gy | ||||
| 0.17 | 1.4 (0.86–2.27) | |||
| Male | ||||
| Female | ||||
| 0.38 | 1.25 (0.75–2.09) | |||
| > 65 | ||||
| < 65 | ||||
| 0.089 | 1.94 (0.90–4.18) | |||
| 2–3 | ||||
| 0–1 | ||||
| 0.065 | 1.78 (0.96–3.31) | |||
| < 4 | ||||
| > 4 | ||||
| 0.34 | 0.72 (0.37–1.40) | |||
| T1–2 | ||||
| T3–4 | ||||
| 0.28 | 1.32 (0.79–2.20) | |||
| N0–2 | ||||
| N3 | ||||
| Brain da/ne | 0.52 | 1.2 (0.68–2.11) | ||
| Liver da/ne | 0.39 | 1.22 (0.76–1.92) | ||
| Bone da/ne | 0.46 | 1.24 (0.70–2.21) | ||
| Adrenal gland da/ne | 0.98 | 0.99 (0.59–1.67) | ||
| Other | 0.84 | 0.95 (0.58–1.56) | ||
| 0.43 | 0.82 (0.51–1.33) | |||
| 1 | ||||
| > 2 | ||||
| 0.71 | 1.13 (0.59–2.16) | |||
| < 4 weeks after ChT | ||||
| > 4 weeks after ChT | ||||
| Yes | ||||
| No |