Thoracic Radiotherapy Benefits Elderly Extensive-Stage Small Cell Lung Cancer Patients with Distant Metastasis

Clinical features and prognosis of advanced intra- and extra-pulmonary neuroendocrine carcinomas

Objective

We examined the clinical features and prognosis of advanced intra- and extra-pulmonary neuroendocrine carcinomas (NECs) to offer additional guidance for the clinical treatment of small-cell lung cancer (SCLC), which is a type of advanced intrapulmonary NEC (IPNECs).

Materials and Methods

The clinical data and survival of 123 patients with advanced IPNECs and extrapulmonary NECs (EPNECs) were obtained. We retrospectively examined the corresponding clinical diagnosis and treatment and investigated the significant factors influencing the survival prognosis of patients with NECs.

Results

There were 90 cases of IPNECs (including 81 cases of SCLC), and 33 cases of EPNECs. The median overall survival (OS) of IPNECs was significantly longer than that of the EPNECs in the gastrointestinal tract and in the other regions (P < 0.05). The median OS of patients with other IPNECs was longer than that of patients with SCLC (P > 0.05). Multivariate analysis demonstrated that age, liver metastasis, number of cycles of first-line chemotherapy, and chest radiotherapy were risk factors influencing OS in patients with NECs (P < 0.05).

Conclusions

The survival of IPNECs was significantly longer than that of EPNECs in the gastrointestinal tract and other regions. Nevertheless, patients with advanced NECs who were older and had liver metastases had a poorer prognosis. Multidisciplinary treatments including multicycle chemotherapy and a combination of chemotherapy and radiotherapy should function significantly in extending the survival of NECs.

Association between radiotherapy and risk of death from cardiovascular diseases in lung and bronchus cancer

Background

Radiotherapy plays an important role in the treatment of lung cancer. However, radiation-related deaths from cardiovascular disease (CVD) are a concern in these patients, and few studies have examined CVD-related death associated with lung cancer. We aimed to evaluate the risk of CVD-related death after radiotherapy in patients with lung and bronchus cancer.

Methods

Data were extracted from the surveillance, epidemiology, and end results database. Propensity score matching (PSM) was applied to reduce possible bias between patients who received radiotherapy and those who did not. The Kaplan-Meier method was used to estimate cardiovascular-specific survival (CVSS), and the log-rank test was used to compare CVSS between the radiotherapy and no radiotherapy groups. Cox proportional hazards regression analysis was performed to estimate the hazard ratio (HR) of CVD-related death.

Results

A total of 225,570 patients with lung and bronchus cancer were included, and 201,282 patients remained after PSM. Radiotherapy was identified as an independent risk factor for CVSS among patients with lung and bronchus cancer before PSM (HR: 1.18, P < 0.001) and after PSM (HR: 1.18, P < 0.001). Patients treated with radiotherapy had a significantly worse CVSS than those who did not receive radiotherapy before PSM (25-year CVSS: 49.9 vs. 56.4%, P = 0.002) and after PSM (25-year CVSS: 48.4 vs. 56.7%, P < 0.001). Radiotherapy was associated with more deaths from heart disease before PSM (81.9 vs. 77.2%, P < 0.001) and after PSM (83.0 vs. 78.7%, P < 0.001).

Conclusion

Radiotherapy is associated with an increased risk of CVD-related death, especially death from heart disease, in patients with lung and bronchus cancer. More efforts are needed to monitor cardiovascular health after radiotherapy.

Role of thoracic radiotherapy in extensive stage small cell lung cancer: a systemic review and meta-analysis

Background

The role of thoracic consolidation radiotherapy in patients with extensive stage small cell lung cancer (ES-SCLC) remains controversial. This study aimed to evaluate the efficacy of thoracic radiotherapy (TRT) in these patients.

Methods

A systematic literature search was performed in PubMed, Embase, and the Cochrane library to identify qualified clinical studies. The hazard ratios (HRs) and 95% confidence intervals (CIs) of overall survival (OS), progression-free survival (PFS) and local recurrence-free survival (LRFS) were extracted, and toxicity of the TRT group versus non-TRT group was analyzed.

Results

A total of 12 studies were included in this meta-analysis, including 936 patients in the TRT group and 1,059 patients in the non-TRT group. The combined results showed that TRT significantly improved OS (HR =0.65; 95% CI: 0.55–0.77, P<0.00001), PFS (HR =0.64; 95% CI: 0.56–0.72, P<0.00001) and LRFS (HR =0.38, 95% CI: 0.26–0.53, P<0.00001). Subgroup analysis showed that OS benefits were observed in patients receiving sequential TRT (HR =0.67; 95% CI: 0.54–0.84, P=0.0006). The addition of TRT significantly improved OS in patients over 65 years of age (HR =0.55; 95% CI: 0.40–0.74, P=0.0001). For patients with only one organ metastasis, there was no significant difference in OS between the two groups (HR =0.61; 95% CI: 0.36–1.01, P=0.06). There was no statistical difference in hematologic toxicity (leukopenia, thrombocytopenia, anemia) and non-hematologic toxicity (nausea or vomiting) between the two groups. The incidence of grade ≥3 esophageal toxicity was 4.6% in the TRT group and 0% in the non-TRT group (P=0.0001). Grade ≥3 bronchopulmonary toxicity was 2.9% in the TRT group and 0.8% in the non-TRT group (P=0.02).

Conclusions

TRT improves OS, PFS and LRFS in patients with ES-SCLC, with a low increase in esophageal and bronchopulmonary toxicity. More randomized controlled trials (RCTs) are expected to confirm our conclusions.

PROSPERO registration number

CRD42020190575.

The benefits of etoposide capsules as maintenance therapy for patients with extensive-stage small cell lung cancer: a prospective two-stage, two-center study

Background

Due to the high incidence and mortality of lung cancer, and etoposide is the standard first-line chemotherapy for small cell lung cancer, to evaluate the efficacy and safety of etoposide capsules at different doses as maintenance therapy for patients with extensive-stage small cell lung cancer (ES-SCLC) who show a response to etoposide plus platinum.

Methods

The study was divided into two stages: stage I, a single-center, one-arm prospective study, and stage II, a multicenter, controlled non-randomized prospective study (patients were chosen from ClinicalTrials.gov Identifier: NCT02179528). All patients received six cycles of etoposide plus platinum. Patients who were evaluated as complete remission (CR) or partial remission (PR) entered the maintenance treatment (MT) (etoposide capsule, once a day for 20 days, every 28 days as a cycle, until disease progression). In stage I, the dose of etoposide was 25 mg; in stage II, patients were non-randomized into etoposide capsule (25 mg/50 mg) and observation groups. In this study, the primary endpoints were progression-free survival (PFS) and safety; the secondary endpoint was overall survival (OS). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v3.0.

Results

Ninety-two patients were enrolled. In stage I, the median PFS was 6.700 months (95% CI: 6.408–6.992). In stage II, the median PFS of the MT group was better than that in the NMT group (8.930 vs. 5.900 months, P=0.002). In the pooled analysis, the overall median PFS of the MT group was better than that of the NMT group (7.870 vs. 5.900 months, P=0.003). However, there was no significant difference in OS between the groups (15.030 vs. 14.330 months, P=0.813). Multivariate Cox regression analysis showed that maintenance therapy was an independent protective factor for PFS in patients with ES-SCLC.

Conclusions

Etoposide capsules as maintenance therapy significantly prolonged the PFS of patients with ES-SCLC who responded to etoposide plus platinum, with acceptable tolerability.