Final report of a prospective randomized study on thoracic radiotherapy target volumes for limited-stage small cell lung cancer
Xiao Hu, Yong Bao, Yujin Xu, Li Zhang, Jin Wang, Honglian Ma, Ying Jin, Xiaoling Xu, Zhengbo Song, Fang Peng, Huarong Tang, Min Fang, Yue Kong, Mengyuan Chen, Baiqiang Dong, Xinmin Yu, Hongyang Lu, Yiping Zhang, Yun Fan, Ming Chen
Abstract
ObjectiveIn view of the controversy over radiotherapy target volume for patients with limited-stage small cell lung cancer (SCLC), a prospective randomized controlled trial was conducted to compare the impact of different radiotherapy target volumes on prognosis.
MethodsAfter 2 cycles of EP chemotherapy, patients without progressive disease were randomly assigned to receive thoracic radiotherapy (TRT) to either the post-or pre-chemotherapy primary tumour extent as study arm or control. Involved field radiotherapy (IFRT) to the entire metastatic lymph node regions was applied for both arms. TRT consisted of 45 Gy/30Fx/19 d administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients achieved complete or partial remission. Kaplan-Meier method was used for survival analysis.
ResultsBetween June 2002 and December 2017, 159 and 150 patients were randomly assigned to study arm and control respectively. The 1-, 2-, and 5-year local/regional control rates were 79.4%, 61.5% and 60.1% respectively in the study arm versus 79.8%, 66.5%, and 57.3% in the control arm (P=0.73). The median OS time was 22.1 months in the study arm (95%CI, 18.2-26.0 months) and 26.9 months (95%CI, 23.5-30.3 months) in the control arm, the 1-, 3-, 5-, and 7-year OS rates were 81.1%, 31.6%, 23.9% and 22.2% respectively in the study arm versus 85.3%, 36.6%, 26.1% and 20.0% in the control arm (P=0.51). Grade 2-3 acute esophagitis was developed in 32.9% and 43.2% of patients respectively in study arm and control arm (P=0.01), while grade 2-3 pulmonary fibrosis was observed in 2.0% and 10.9% of patients (P=0.01) respectively.
ConclusionsFor patients with limited-stage SCLC who received induction chemotherapy, thoracic radiotherapy can be limited to post-chemotherapy tumour extent and IFRT can be routinely applied.
Key words:
Lung neoplasms/radiotherapy; Radiotherapy target volume; Prospective study
Contributor Information
Xiao Hu
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Yong Bao
Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510060, China
Yujin Xu
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Li Zhang
Department of Medical Oncology, Cancer Center of Sun Yat-sen University, Guangzhou 510060, China
Jin Wang
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Honglian Ma
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Ying Jin
Department of Medical Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Xiaoling Xu
Department of Medical Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Zhengbo Song
Department of Medical Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Fang Peng
Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510060, China
Huarong Tang
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Min Fang
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Yue Kong
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Mengyuan Chen
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Baiqiang Dong
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Xinmin Yu
Department of Medical Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Hongyang Lu
Department of Medical Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Yiping Zhang
Department of Medical Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Yun Fan
Department of Medical Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China
Ming Chen
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou 310022, China