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Tian S, Zhang X, Jiang R, Pillai RN, Owonikoko TK, Steuer CE, Saba NF, Pakkala S, Patel PR, Belani CP, Khuri FR, Curran WJ, Ramalingam SS, Behera M, Higgins KA. Survival Outcomes With Thoracic Radiotherapy in Extensive-Stage Small-Cell Lung Cancer: A Propensity Score-Matched Analysis of the National Cancer Database. Clin Lung Cancer 2019; 20:484-493.e6. [PMID: 31296433 DOI: 10.1016/j.cllc.2019.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prognosis of patients with extensive-stage small-cell lung carcinoma (ES-SCLC) is poor. The benefit of consolidative thoracic radiation therapy (TRT) in ES-SCLC has been inconclusive, and its use inconsistent. The objective of this study was to evaluate overall survival (OS) of ES-SCLC patients treated with chemotherapy (CT) with or without TRT using an administrative database approach. PATIENTS AND METHODS The National Cancer Database was queried to identify patients with ES-SCLC diagnosed between 2010 and 2014. Those with brain metastases, those who received radiotherapy before CT, or radiotherapy outside the thorax, were excluded. Propensity score-matching (PSM) was used to compare OS of patients treated with CT and TRT with those who received CT alone. Patients who received >10 radiotherapy fractions were also compared with those who received 10 or fewer. RESULTS We included 14,367 patients in the primary analysis; 12,019 received CT alone, and 2348 received CT with TRT. In multivariate analysis, CT was associated with an increased risk of death relative to CT with TRT (hazard ratio [HR], 1.74 [95% confidence interval (CI), 1.64-1.84]; log-rank P < .001), which remained significant with PSM. Median OS was 12.1 versus 8.2 months (CT with TRT vs. CT); 12-month OS was 50.5% versus 28.5%, and 5-year OS 7.6% versus 2.0% (HR, 1.80 [95% CI, 1.67-1.95], HR P < .001). Of 3099 patients who received TRT, >10 radiotherapy fractions was associated with superior OS (HR, 1.70 [95% CI, 1.49-1.95], log-rank P < .001); this finding remained significant with PSM. CONCLUSION Use of TRT after CT in ES-SCLC patients was associated with long-term survival; its use should be considered in addition to standard of care CT.
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Affiliation(s)
- Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Xinyan Zhang
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Renjian Jiang
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rathi N Pillai
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Suchita Pakkala
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Chandra P Belani
- Department of Medicine, Penn State Hershey Cancer Institute, Hershey, PA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Madhusmita Behera
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA.
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Slotman BJ, van Tinteren H, Praag JO, Knegjens JL, El Sharouni SY, Hatton M, Keijser A, Faivre-Finn C, Senan S. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 2015; 385:36-42. [PMID: 25230595 DOI: 10.1016/s0140-6736(14)61085-0] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Most patients with extensive stage small-cell lung cancer (ES-SCLC) who undergo chemotherapy, and prophylactic cranial irradiation, have persistent intrathoracic disease. We assessed thoracic radiotherapy for treatment of this patient group. METHODS We did this phase 3 randomised controlled trial at 42 hospitals: 16 in Netherlands, 22 in the UK, three in Norway, and one in Belgium. We enrolled patients with WHO performance score 0-2 and confirmed ES-SCLC who responded to chemotherapy. They were randomly assigned (1:1) to receive either thoracic radiotherapy (30 Gy in ten fractions) or no thoracic radiotherapy. All underwent prophylactic cranial irradiation. The primary endpoint was overall survival at 1 year in the intention-to-treat population. Secondary endpoints included progression-free survival. This study is registered with the Nederlands Trial Register, number NTR1527. FINDINGS We randomly assigned 498 patients between Feb 18, 2009, and Dec 21, 2012. Three withdrew informed consent, leaving 247 patients in the thoracic radiotherapy group and 248 in the control group. Mean interval between diagnosis and randomisation was 17 weeks. Median follow-up was 24 months. Overall survival at 1 year was not significantly different between groups: 33% (95% CI 27-39) for the thoracic radiotherapy group versus 28% (95% CI 22-34) for the control group (hazard ratio [HR] 0.84, 95% CI 0.69-1.01; p=0.066). However, in a secondary analysis, 2-year overall survival was 13% (95% CI 9-19) versus 3% (95% CI 2-8; p=0.004). Progression was less likely in the thoracic radiotherapy group than in the control group (HR 0.73, 95% CI 0.61-0.87; p=0.001). At 6 months, progression-free survival was 24% (95% CI 19-30) versus 7% (95% CI 4-11; p=0.001). We recorded no severe toxic effects. The most common grade 3 or higher toxic effects were fatigue (11 vs 9) and dyspnoea (three vs four). INTERPRETATION Thoracic radiotherapy in addition to prophylactic cranial irradiation should be considered for all patients with ES-SCLC who respond to chemotherapy. FUNDING Dutch Cancer Society (CKTO), Dutch Lung Cancer Research Group, Cancer Research UK, Manchester Academic Health Science Centre Trials Coordination Unit, and the UK National Cancer Research Network.
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Affiliation(s)
- Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
| | - Harm van Tinteren
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - John O Praag
- Department of Radiation Oncology, Erasmus MC, Rotterdam, Netherlands
| | - Joost L Knegjens
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sherif Y El Sharouni
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matthew Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Astrid Keijser
- IKNL Clinical Research Department, Amsterdam, Netherlands
| | | | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
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Puglisi M, Dolly S, Faria A, Myerson JS, Popat S, O'Brien MER. Treatment options for small cell lung cancer - do we have more choice? Br J Cancer 2010; 102:629-38. [PMID: 20104223 PMCID: PMC2837580 DOI: 10.1038/sj.bjc.6605527] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 12/02/2009] [Accepted: 12/08/2009] [Indexed: 01/22/2023] Open
Abstract
Small cell lung cancer (SCLC) is a significant health problem worldwide because of its high propensity for relapse. This review discusses existing and future therapies for the treatment of SCLC.
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Affiliation(s)
- M Puglisi
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S Dolly
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - A Faria
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - J S Myerson
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S Popat
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - M E R O'Brien
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
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