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Graabak G, Grønberg BH, Sandvei MS, Nilssen Y, Halvorsen TO. Thoracic Radiotherapy in Limited-Stage Small-Cell Lung Cancer – a Population-Based Study of Patterns of Care in Norway from 2000 until 2018. JTO Clin Res Rep 2021; 3:100270. [PMID: 35146461 PMCID: PMC8801751 DOI: 10.1016/j.jtocrr.2021.100270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Twice-daily (BID) thoracic radiotherapy (TRT) of 45 Gy per 30 fractions is recommended for limited-stage (LS) SCLC, but most patients are treated with once-daily (OD) schedules owing to toxicity concerns and logistic challenges. An alternative is hypofractionated OD TRT of 40 to 42 Gy per 15 fractions. A randomized trial by our group indicated that TRT of 45 Gy per 30 fractions is more effective than TRT of 42 Gy per 15 fractions, and because it was not more toxic, 45 BID replaced 42 OD as the recommended schedule in Norway. The aims of this study were to evaluate to what extent BID TRT has been implemented in Norway and whether this practice change has led to improved survival. Methods Data on all patients diagnosed with LS SCLC from 2000 until 2018 were collected from the Cancer Registry of Norway, containing nearly complete data on cancer diagnosis, radiotherapy, and survival. Results A total of 2222 patients were identified; median age was 69 years, 51.8% were women, and 87.1% had stage II to III disease. Overall, 64.6% received TRT. The use of BID TRT increased from 1.8% (2000–2004) to 83.2% (2015–2018). Median overall survival among patients receiving curative TRT improved significantly during the study period (2000–2004: 17.9 mo, 2015–2018: 25.0 mo, p = 0.0023), and patients receiving 45 BID had significantly longer median overall survival than patients receiving 42 OD (BID: 26.2 mo, OD: 19.6 mo, p = 0.0015). Conclusions BID TRT has replaced hypofractionated OD TRT as the standard treatment of LS SCLC in Norway which has led to a significant (p = 0.0023) and clinically relevant survival improvement.
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Affiliation(s)
- Gustav Graabak
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Henning Grønberg
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Oncology, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marie Søfteland Sandvei
- Department of Oncology, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Tarje Onsøien Halvorsen
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Oncology, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Corresponding author. Address for correspondence: Tarje Onsøien Halvorsen, MD, PhD, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
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Nesbit EG, Leal TA, Kruser TJ. What is the role of radiotherapy for extensive-stage small cell lung cancer in the immunotherapy era? Transl Lung Cancer Res 2019; 8:S153-S162. [PMID: 31673520 DOI: 10.21037/tlcr.2019.05.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Small cell lung cancer has been a difficult disease to treat with poor survival and few significant improvements in outcomes in the last three decades. Most recently the addition of atezolizumab to chemotherapy in the first-line treatment of extensive-stage small cell lung cancer (ES-SCLC) resulted in improved overall survival and progression-free survival compared to chemotherapy alone. Recent randomized studies examining both consolidative thoracic radiotherapy and prophylactic cranial irradiation (PCI) in ES-SCLC have impacted the utilization of these interventions. The approval of immune checkpoint inhibitors (ICIs) to platinum/etoposide chemotherapy for the treatment of ES-SCLC in the front-line setting may also further impact the role of radiotherapy in this disease. In this article, we review the current evidence supporting thoracic radiotherapy in ES-SCLC and discuss the promising therapeutic implications of thoracic radiation in light of the inclusion of ICIs. We also address how the increasing routine use of surveillance brain magnetic resonance imaging (MRI) and ICIs may diminish the use of PCI in ES-SCLC.
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Affiliation(s)
- Eric G Nesbit
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ticiana A Leal
- Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Tim J Kruser
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Liu J, Zhou H, Zhang Y, Fang W, Yang Y, Hong S, Chen G, Zhao S, Chen X, Zhang Z, Xian W, Shen J, Huang Y, Zhao H, Zhang L. Cause-specific death assessment of patients with stage I small-cell lung cancer: a competing risk analysis. Future Oncol 2019; 15:2479-2488. [PMID: 31238738 DOI: 10.2217/fon-2018-0888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Aim: Stage I small-cell lung cancer (SCLC) is a potentially curable disease that needs timely and multidisciplinary management. The aim of this study was to evaluate the probability of cause-specific mortality for patients with stage I SCLC. Material & methods: We identified patients in the SEER database and constructed a proportional subdistribution hazard model to evaluate cancer-specific mortality. A nomogram was built based on Fine and Gray competing risk regression model. Results: A total of 864 stage I SCLC patients were identified. The 5-year cumulative incidence of SCLC-specific mortality was 56.2%, while that for other causes of death was 17.3%. The c-index for the prognostic prediction model was 0.66. Besides, the nomogram was well calibrated. Conclusion: Our nomogram might serve as a reference for clinicians when evaluating the prognosis of stage I SCLC.
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Affiliation(s)
- Jiaqing Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Gang Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Shen Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Xi Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Wei Xian
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Jiayi Shen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Hongyun Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
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