Asian Pacific Journal of Cancer Prevention

  • 제15권15호
  • /
  • Pages.6263-6267
  • /
  • 2014
  • /
  • 1513-7368(pISSN)
  • /
  • 2476-762X(eISSN)
아시아태평양암예방학회 (Asian Pacific Journal of Cancer Prevention)
권호 표지
DOI QR코드

DOI QR Code

Timing of Thoracic Radiotherapy in Limited Stage Small Cell Lung Cancer: Results of Early Versus Late Irradiation from a Single Institution in Turkey

  • Bayman, Evrim (Department of Radiation Oncology, Medical Faculty, Eskisehir Osmangazi University) ;
  • Etiz, Durmus (Department of Radiation Oncology, Medical Faculty, Eskisehir Osmangazi University) ;
  • Akcay, Melek (Department of Radiation Oncology, Medical Faculty, Eskisehir Osmangazi University) ;
  • Ak, Guntulu (Department of Chest Diseases, Medical Faculty, Eskisehir Osmangazi University)
  • 발행 : 2014.08.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: It is standard treatment to combine chemotherapy (CT) and thoracic radiotherapy (TRT) in treating patients with limited stage small cell lung cancer (LS-SCLC). However, optimal timing of TRT is unclear. We here evaluated the survival impact of early versus late TRT in patients with LS-SCLC. Materials and Methods: Follow-up was retrospectively analyzed for seventy consecutive LS-SCLC patients who had successfully completed chemo-TRT between January 2006 and January 2012. Patients received TRT after either 1 to 2 cycles of CT (early TRT) or after 3 to 6 cycles of CT (late TRT). Survival and response rates were evaluated using the Kaplan-Meier method and comparisons were made using the multivariate Cox regression test. Results: Median follow-up was 24 (5 to 57) months. Carboplatin+etoposide was the most frequent induction CT (59%). Median overall, disease free, and metastasis free survivals in all patients were 15 (5 to 57), 5 (0 to 48) and 11 (3 to 57) months respectively. Late TRT was superior to early TRT group in terms of response rate (p=0.05). 3 year overall survival (OS) rates in late versus early TRT groups were 31% versus 17%, respectively (p=0.03). Early TRT (p=0.03), and incomplete response to TRT (p=0.004) were negative predictors of OS. Significant positive prognostic factors for distant metastasis free survival were late TRT (p=0.03), and use of PCI (p=0.01). Use of carboplatin versus cisplatin for induction CT had no significant impact on OS (p=0.634), DFS (p=0.727), and MFS (p=0.309). Conclusions: Late TRT appeared to be superior to early TRT in LS-SCLC treatment in terms of complete response, OS and DMFS. Carboplatin or cisplatin can be combined with etoposide in the induction CT owing to similar survival outcomes.

키워드

참고문헌

  1. Chen YT, Feng B, Chen LB (2012). Update of research on drug resistance in small cell lung cancer chemotherapy. Asian Pac J Cancer Prev, 13, 3577-81. https://doi.org/10.7314/APJCP.2012.13.8.3577
  2. De Ruysscher D, Pijls-Johannesma M, Bentzen SM, et al (2006). Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small cell lung cancer. J Clin Oncol, 24, 1057-63. https://doi.org/10.1200/JCO.2005.02.9793
  3. De Ruysscher D, Paris E, Le Pechoux C, et al (2011). A metaanaysis of randomized trials using individual patient data on the timing of chest radiotherapy in patients with limited stage small cell lung cancer. J Thorac Oncol, 6, S641-2. https://doi.org/10.1097/JTO.0b013e3182037c80
  4. Erridge SC, Murray N (2003). Thoracic radiotherapy for limitedstage small cell lung cancer: issues of timing, volumes, dose, and fractionation. Semin Oncol, 30, 26-37.
  5. Fried DB, Morris DE, Poole C, et al (2004). Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small cell lung cancer. J Clin Oncol, 22, 4837-45. https://doi.org/10.1200/JCO.2004.01.178
  6. Govindan R, Page N, Morgensztern D, et al (2006). Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol, 24, 4539-44. https://doi.org/10.1200/JCO.2005.04.4859
  7. Huncharek M, McGarry R (2004). A meta-analysis of the timing of chest irradiation in the combined modality treatment of limited-stage small cell lung cancer. Oncologist, 9, 665-72. https://doi.org/10.1634/theoncologist.9-6-665
  8. Intaraphet S, Kasatpibal N, Siriaunkgul S, et al (2013). Prognostic impact of histology in patients with cervical squamous cell carcinoma, adenocarcinoma and small cell neuroendocrine carcinoma. Asian Pac J Cancer Prev, 14, 5355-60. https://doi.org/10.7314/APJCP.2013.14.9.5355
  9. Karam I, Jiang SY, Khaira M, Lee CW, Schellenberg D (2013). Outcomes of small cell lung cancer patients treated with cisplatin-etoposide versus carboplatin-etoposide. Am J Clin Oncol, (in press).
  10. Murray N, Coy P, Pater JL, et al (1993). Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol, 11, 336-44.
  11. Rossi A, Di Maio M, Chiodini P, et al (2012). Carboplatinor Cisplatin-based chemotherapy in first-line treatment of small-cell lung cancer: the COCIS meta-analysis of individual patient data. J Clin Oncol, 30, 1692-8. https://doi.org/10.1200/JCO.2011.40.4905
  12. Rossi A, Martelli O, Di Maio M (2013). Treatment of patients with small-cell lung cancer: from meta-analyses to clinical practice. Cancer Treat Rev, 39, 498-506. https://doi.org/10.1016/j.ctrv.2012.09.006
  13. Oguz A, Unal D, Tasdemir A (2013). Lack of any association between blood groups and lung cancer independent of histology. Asian Pac J Cancer Prev, 14, 453-6. https://doi.org/10.7314/APJCP.2013.14.1.453
  14. Spiro SG, James LE, Rudd RM, et al (2006). Early compared with late radiotherapy in combined modality treatment for limited disease small-cell lung cancer. A London lung cancer group multicenter randomized clinical trial and metaanalysis. J Clin Oncol, 24, 3823-30. https://doi.org/10.1200/JCO.2005.05.3181
  15. Sun JM, Ahn YC, Choi EK, et al (2013). Phase III trial of concurrent thoracic radiotherapy with either first- or thirdcycle chemotherapy for limited-disease small-cell lung cancer. Ann Oncol, 24, 2088-92. https://doi.org/10.1093/annonc/mdt140
  16. Takada M, Fukuoka M, Kawahara M, et al (2002). Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol, 20, 3054-60. https://doi.org/10.1200/JCO.2002.12.071
  17. Turrisi AT 3rd, Kim K, Blum R, et al (1999). Twice-daily compared with once-daily thoracic radiation therapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med, 340, 265-71. https://doi.org/10.1056/NEJM199901283400403
  18. Warde P, Payne D (1992). Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol, 10, 890-5.
  19. Wu C, Li F, Jiao SC (2012). Prognostic factors for survival of patients with extensive stage small cell lung cancer-a retrospective single institution analysis. Asian Pac J Cancer Prev, 13, 4959-62. https://doi.org/10.7314/APJCP.2012.13.10.4959
  20. Yee D, Hanson J, Butts C, et al (2010). Phase I dose escalation trial of hypofractionated limited-field external beam thoracic radiotherapy for limited-stage small cell carcinoma for the lung. Radiother Oncol, 96, 78-83. https://doi.org/10.1016/j.radonc.2010.05.013
  21. Zhao H, Gu J, Hua F, et al (2010). A meta-analysis of the timing of chest radiotherapy in patients with limited-stage small cell lung cancer. Zhongguo Fei Ai Za Zhi, 13, 892-7.
  22. Zhao X, Sun X, Li Xl (2012). Expression and clinical significance of STAT3, P-STAT3, and VEGF-C in small cell lung cancer. Asian Pac J Cancer Prev, 13, 2873-7. https://doi.org/10.7314/APJCP.2012.13.6.2873