Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer : A single-centre retrospective study

Efficacy evaluation of prophylactic cranial irradiation for limited stage small‑cell lung cancer in the magnetic resonance imaging era: A meta‑analysis

The role of prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (LS-SCLC) remains controversial in the era of magnetic resonance imaging (MRI). The present study aimed to evaluate the effectiveness of PCI in the treatment of LS-SCLC in the era of MRI. The PubMed, EMBASE and Cochrane Library databases were searched from the time of database creation until May 24, 2023, to identify clinical studies that evaluated the effectiveness of PCI in patients with LS-SCLC in the MRI era. The references of the obtained studies were also reviewed to identify clinical studies that were not discovered in the initial search. All studies were screened in accordance with the inclusion criteria, and the data were extracted and subjected to meta-analysis using STATA17.0. In total, 21 studies were included in the analysis. Notably, 10 studies only used brain MRI at baseline to confirm the absence of brain metastases (BMs; pre-chemoradiotherapy MRI group), 7 studies used brain MRI prior to PCI to confirm the absence of BMs (pre-PCI MRI group) and 4 studies used active surveillance in the form of brain MRI following PCI (MRI surveillance group). The results of the meta-analysis demonstrated that for all included patients, PCI was associated with a significant improvement in overall survival time [OS; hazard ratio (HR), 0.61; confidence interval (CI), 0.53-0.70] and progression-free survival (HR, 0.69; CI, 0.61-0.79), as well as a significant decrease in the rate of BM (HR, 0.59; CI, 0.50-0.70). Subgroup analyses revealed that PCI remained effective in improving OS and reducing the rate of BM in patients with LS-SCLC who did not have BMs confirmed via brain MRI performed at baseline or prior to PCI. However, in the MRI surveillance group, PCI failed to significantly improve the OS (HR, 0.65; CI, 0.41-1.05), despite significantly reducing the BM rate (HR, 0.6; CI, 0.45-0.8) of LS-SCLC. Collectively, the results of the present study demonstrated that PCI remained effective in improving OS and reducing the rate of BM in patients with LS-SCLC who had the absence of BM confirmed via brain MRI at baseline or prior to PCI. Additionally, in patients with LS-SCLC who had undergone active surveillance using brain MRI following PCI, the incidence of BM was reduced, while the OS was not significantly improved. However, additional randomized controlled clinical studies are required to verify these findings.

Incidence and Treatment Outcome of Radiation Pneumonitis in Patients With Limited-stage Small Cell Lung Cancer Treated With Concurrent Accelerated Hyperfractionated Radiation Therapy and Chemotherapy

Purpose

This study aimed to clarify the characteristics of and evaluate the risk factors for radiation pneumonitis (RP) induced by chemoradiation therapy (CRT) using accelerated hyperfractionated (AHF) radiation therapy (RT) in patients with limited-stage small cell lung cancer (LS-SCLC).

Methods and Materials

Between September 2002 and February 2018, 125 patients with LS-SCLC were treated with early concurrent CRT using AHF-RT. Chemotherapy was comprised of carboplatin/cisplatin with etoposide. RT was administered twice daily (45 Gy/30 fractions). We collected data regarding onset and treatment outcomes for RP, and analyzed the relationship between RP and total lung dose-volume histogram findings. Uni- and multivariate analyses were performed to assess patient- and treatment-related factors for grade ≥2 RP.

Results

The median age of patients was 65 years, and 73.6% of participants were men. In addition, 20% and 80.0% of participants presented with disease stage II and III, respectively. The median follow-up time was 73.1 months. Grades 1, 2, and 3 RP were observed in 69, 17, and 12 patients, respectively. Grades 4 to 5 RP were not observed. RP was treated with corticosteroids in patients with grade ≥2 RP, without recurrence. The median time from initiation of RT to onset of RP was 147 days. Three patients developed RP within 59 days, 6 within 60 to 89 days, 16 within 90 to 119 days, 29 within 120 to 149 days, 24 within 150 to 179 days, and 20 within ≥180 days. Among the dose-volume histogram parameters, the percentage of lung volume receiving >30 Gy (V₃₀) was most strongly related to the incidence of grade ≥2 RP, and the optimal threshold to predict RP incidence was V₃₀ ≥20%. On multivariate analysis, V₃₀ ≥20% was an independent risk factor for grade ≥2 RP.

Conclusions

The incidence of grade ≥2 RP correlated strongly with a V₃₀ of ≥20%. Contrarily, the onset of RP induced by concurrent CRT using AHF-RT may occur later. RP is manageable in patients with LS-SCLC.

Real-world treatment patterns and outcomes in small-cell lung cancer: a systematic literature review

Background

Small-cell lung cancer (SCLC) accounts for 12-15% of lung cancers and is associated with poor survival outcomes and high symptom burden. This study employed a broad, systematic search strategy and timeframe to identify evidence on real-world treatment patterns and outcomes for SCLC outside the USA, including understanding sub-populations such as extensive-stage (ES) or limited-stage (LS) disease.

Methods

Databases (MEDLINE, Embase, and EBM reviews) were searched for journal articles published in the English language between 1 January 2000-1 March 2020 and supplemented by hand searching of conference abstracts and posters presented at conferences between 1 January 2016-1 March 2020 reporting real-world treatment outcomes in patients with SCLC. A targeted clinical guideline review was also completed.

Results

One-hundred studies provided quantitative data; 57 were available as full-text articles, whilst the remaining 43 were presented as abstracts or posters. The majority (80 studies, 80%) of included studies reported treatment in the first-line setting, where platinum-based chemotherapy and chemoradiotherapy was the most commonly used treatment strategy, in line with current treatment guidelines in SCLC. First-line treatments were found to have a high response rate; however, most patients relapsed early. No studies reported treatment or outcomes with immune-oncology therapies. Second-line treatment options were very limited, and primarily consisted of either re-treatment with first-line regimen or topotecan, but the prognosis for these patients remained poor. Outcomes were particularly poor amongst those with ES or relapsed disease vs. LS disease.

Conclusions

SCLC treatment patterns and short survival outcomes have remained constant over the previous 20 years. Due to the search timeframe, none of the studies identified reported on the impact of recently approved immune-oncology therapies in SCLC. Further data is needed on the impact of immunotherapies on treatment patterns and real-world outcomes in SCLC.

Changes of lung parenchyma density following high dose radiation therapy for thoracic carcinomas - an automated analysis of follow up CT scans

Background

An objective way to qualify the effect of radiotherapy (RT) on lung tissue is the analysis of CT scans after RT. In this analysis we focused on the changes in Hounsfield units (ΔHU) and the correlation with the corresponding radiation dose after RT.

Methods

Pre- and post-RT CT scans were matched and ΔHU was calculated using customized research software. ΔHU was calculated in 5-Gy-intervals and the correlation between ΔHU and the corresponding dose was calculated as well as the regression coefficients. Additionally the mean ΔHU and ΔHU in 5-Gy-intervals were calculated for each tumor entity.

Results

The mean density changes at 12 weeks and 6 months post RT were 28,16 HU and 32,83 HU. The correlation coefficient between radiation dose and ΔHU at 12 weeks and 6 months were 0,166 (p = 0,000) and 0,158 (p = 0,000). The resulting regression coefficient were 1439 HU/Gy (p = 0,000) and 1612 HU/Gy (p = 0,000). The individual regression coefficients for each patient range from − 2,23 HU/Gy to 7,46 HU/Gy at 12 weeks and − 0,45 HU/Gy to 10,51 HU/Gy at 6 months. When looking at the three tumor entities individually the highest ΔHU at 12 weeks was seen in patients with SCLC (38,13 HU) and at 6 month in those with esophageal carcinomas (40,98 HU).

Conclusion

For most dose intervals there was an increase of ΔHU with an increased radiation dose. This is reflected by a statistically significant, although low correlation coefficient. The regression coefficients of all patients show large interindividual differences.

Preexisting radiological interstitial lung abnormalities are a risk factor for severe radiation pneumonitis in patients with small-cell lung cancer after thoracic radiation therapy

BACKGROUND

Previous studies reported that patients with preexisting radiological interstitial lung abnormalities (ILAs) were more susceptible to developing radiation pneumonitis (RP) after thoracic radiation therapy (TRT). The present study aimed to evaluate the incidence and predictors of RP after TRT in patients with small-cell lung cancer (SCLC) with or without preexisting radiological ILAs.

METHODS

A total of 95 consecutive patients with SCLC between January 2015 and December 2015, who were treated with thoracic intensity-modulated radiation therapy at Shanghai Pulmonary Hospital,Tongji University School of Medicine, were analyzed. The diagnosis of ILAs was reviewed by two experienced thoracic radiologists based on the pretreatment high-resolution computed tomography imaging, such as honeycombing, subpleural reticular opacities, ground-glass opacity, and traction bronchiectasis. Univariate and multivariate analyses were used to assess the correlation of clinical factors, preexisting radiological ILAs, and dose-volume histogram-based dosimetric parameters with RP.

RESULTS

Fifteen (15.8%) patients had preexisting radiological ILAs. The incidence of ≥ grade 2 and 3 RP at 1 year was 27.1% and 12.7% in the entire cohort, respectively. Preexisting radiological ILAs were associated with an increased risk of ≥grade 2 RP (50.0% in ILAs + vs 23.3% in ILAs-, P = 0.017) and ≥ grade 3 RP (35.8% in ILAs + vs 8.9% in ILAs-, P = 0.005) at 1 year. Preexisting radiological ILAs and smoking history (≥40 pack-years of smoking) were significant predictors of ≥grade 3 RP in multivariate analysis (P = 0.023 and 0.012, respectively).

CONCLUSIONS

Preexisting radiological ILAs and smoking history (≥40 pack-years of smoking) are associated with an increased risk of ≥grade 3 RP after TRT in patients with SCLC.