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Kim BH, Chung JH, Son J, Kim S, Wu HG, Kim HJ. Analysis of Once-Daily Thoracic Radiotherapy Dose According to the Underlying Lung Disease in Patients with Limited-Stage Small Cell Lung Cancer Undergoing Concurrent Chemoradiotherapy. Cancer Res Treat 2023; 55:73-82. [PMID: 35287254 PMCID: PMC9873322 DOI: 10.4143/crt.2021.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE In the treatment of concurrent chemoradiotherapy (CCRT) in limited-stage small cell lung cancer, the optimal once-daily radiotherapy (RT) dose/fractionation remain unclear although it is the most frequently used. Therefore, this study aimed to compare the treatment outcomes and toxicities of modest dose RT (≤ 54 Gy) with those of standard dose RT (> 54 Gy) and investigate the benefit of the high dose based on patient factors. MATERIALS AND METHODS Since 2004, our institution has gradually increased the thoracic RT dose. Among the 225 patients who underwent CCRT, 84 patients (37.3%) received > 54 Gy. Because the patients treated with RT > 54 Gy were not randomly assigned, propensity score matching (PSM) was performed. RESULTS The proportion of patients treated with > 54 Gy increased over time (p=0.014). Multivariate analysis revealed that the overall tumor stage and dose > 54 Gy (hazard ratio, 0.65; p=0.029) were independent prognostic factors for overall survival (OS). PSM confirmed that thoracic RT doses of > 54 Gy showed significantly improved progression-free survival (3-year, 42.7% vs. 24.0%; p < 0.001) and OS (3-year, 56.2% vs. 38.5%; p=0.003). Sensitivity analysis also showed that 60 Gy resulted in better survival than 54 Gy. However, in patients with underlying lung disease, OS benefit from > 54 Gy was not observed but considerable rates of severe pulmonary toxicities were observed (p=0.001). CONCLUSION Our analysis supports that the 60 Gy RT dose should be considered in the once-daily regimen of CCRT for limited-stage small cell lung cancer without underlying lung disease, but RT dose > 54 Gy did not seem to benefit for patients with chronic obstructive pulmonary disease or interstitial lung disease. Further study is needed to validate these results.
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Affiliation(s)
- Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea
| | - Joo-Hyun Chung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea,Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea,Department of Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul,
Korea,Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea,Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea,Department of Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul,
Korea,Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
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Zhang B, Birer SR, Dvorkin M, Shruti J, Byers L. New Therapies and Biomarkers: Are We Ready for Personalized Treatment in Small Cell Lung Cancer? Am Soc Clin Oncol Educ Book 2021; 41:1-10. [PMID: 33979194 DOI: 10.1200/edbk_320673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Small cell lung cancer (SCLC) is an aggressive form of lung cancer with a 5-year survival rate of less than 7%. In contrast to non-small cell lung cancer, SCLC has long been treated as a homogeneous disease without personalized treatment options. In recent years, the incorporation of immunotherapy into the treatment paradigm has brought moderate benefit to patients with SCLC; however, more effective therapies are urgently needed. In this article, we describe the current treatment standards and emerging therapeutic approaches for the treatment of SCLC. We also discuss promising biomarkers in SCLC and the recently discovered four subtypes of SCLC, each with its unique therapeutic vulnerability. Lastly, we discuss the advances in radiation therapy for the treatment of SCLC.
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Affiliation(s)
- Bingnan Zhang
- Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - Samuel R Birer
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Mikhail Dvorkin
- BHI of Omsk Region Clinical Oncology Dispensary, Omsk, Russia
| | - Jolly Shruti
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Lauren Byers
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX
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