Definitive chemoradiotherapy of limited-disease small cell lung cancer: Retrospective analysis of new predictive factors affecting treatment results

One Cycle of Concurrent Chemotherapy vs. Two Cycles of Concurrent Chemotherapy With Radiation Therapy in Patients With Limited-Stage Small Cell Lung Cancer

Background

The optimal number of concurrent chemotherapy cycles during thoracic radiotherapy (RT) in patients with limited stage-small cell lung cancer (LS-SCLC) is not well defined. The purpose of this study was to evaluate the impact of the number of concurrent chemotherapy cycles on prognosis of LS-SCLC.

Material and Methods

Patients with LS-SCLC treated with concurrent chemo-radiotherapy from May 2008 to December 2020 in our hospital were retrospectively analyzed. The prescribed radiation dose was 60Gy administrated with conventional RT in 30 fractions within 6 weeks. The prognostic role of cycle number of chemotherapy administrated concurrently with RT were analyzed. All patients were followed up at one month after the treatment, then once every three months until two years after the treatment, and every six months thereafter. Propensity score matching (PSM) was performed to reduce confounding factors. The primary endpoint was overall survival (OS). Survival analysis was performed with Kaplan-Meier and multivariate analysis was performed with Cox regression model.

Results

Among the 370 patients who received radical radiotherapy, 206 patients received concurrent chemo-radiotherapy and were included for the analysis. Multivariate analysis showed that stage and PCI were independent prognostic factors for OS. The median OS in patients who received one cycle and two cycles of chemotherapy concurrently with RT were 32.9 months and 31.6 months, respectively (P = 0.241). And the median PFS were 20.6 months and 18.4 months, respectively (P = 0.764). After PSM, no statistical differences in OS and PFS were observed between patients who received one cycle and those who received two cycles of concurrent chemotherapy.

Conclusion

Two cycles of concurrent chemotherapy during RT were not necessarily superior compared to one cycle in LS-SCLC. The optimal cycle number of concurrent chemotherapy during RT needs to be further studied.

[Utility of NSE, ProGRP and LDH in Diagnosis and Treatment in Patients with Small Cell Lung Cancer]

BACKGROUND

Small cell lung cancer (SCLC) is a rapidly growing tumor with characteristic of neuroendocrine cellular function. Neuron specific enolase (NSE), pro-gastrin-releasing peptide (ProGRP) and lactic dehydrogenase (LDH) are valuable in diagnosis and treatment of SCLC. By analyzing the variation of NSE, ProGRP and LDH before and after treatment, the aim of this study is to investigate the efficacy of tumor markers in diagnostic staging, therapeutic evaluation and prediction of disease relapsing.

METHODS

Patients with SCLC who receiving the first line chemotherapy in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled and retrospectively analyzed. Clinical characteristic (includes NSE, ProGRP and LDH level before and after 2 cycles chemotherapy), efficacy evaluation, progression-free survival (PFS) were analyzed.

RESULTS

Before treatment, Serum NSE, ProGRP and LDH in patients with extensive disease (ED) were significantly higher than those with limited disease (LD)(all P<0.005); NSE level increased obviously accompanied by increase of lymph nodes stage in LD group (P=0.010); Patients with weight reduction when diagnosis had higher NSE and LDH than those without loss of weight (P=0.032, P=0.014). After 2 cycles chemotherapy, decrease of NSE and ProGRP in effective group was higher than which in stable and ineffective groups (P=0.015, P=0.002). The relapse risk was lower in patients who accepted >4 cycles chemotherapy and with obvious decrease of ProGRP than those who accepted ≤4 cycles chemotherapy and with less obvious decrease of ProGRP in LD group; ED patients with no more than 2 distant metastasis, normal LDH level before treatment and obvious decrease of ProGRP after chemotherapy had lower short term relapse risk. In addition, the types of relapse (sensitive relapse, drug resistance relapse and refractory relapse) were negatively correlated with decrease of ProGRP (P=0.044). By multivariate analysis, numbers of chemotherapy cycle was independent prognostic factor for PFS in LD SCLC; numbers of distant metastasis and decrease of ProGRP were independent prognostic factors for PFS in ED SCLC.

CONCLUSIONS

Increase level of serum tumor markers is related to tumor burden. Decrease level of ProGRP after treatment may prognose efficacy and relapse risk.

Does the response to induction chemotherapy impact the timing of thoracic radiotherapy for limited-stage small-cell lung cancer?

BACKGROUND

To investigate whether the response to induction chemotherapy (IC) would impact the timing of thoracic radiotherapy (TRT) in limited-stage small-cell lung cancer (LS-SCLC).

METHODS

A total of 146 patients with LS-SCLC who had received two to six cycles of IC followed by TRT from January 2009 to December 2011 at our hospital were included in this study. Patients were divided into two groups based on the time TRT was administered: early TRT (administered after 2-3 cycles of chemotherapy) or late TRT (administered after 4-6 cycles). Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Multivariate Cox regression analysis was performed to evaluate the independent factors affecting survival.

RESULTS

The median OS for patients who received early TRT and late TRT was 29.0 and 19.9 months, respectively, (P = 0.018) and the median PFS was 18.5 and 13.8 months, respectively (P = 0.049). In patients who achieved complete remission (CR) or partial remission (PR) after two to three cycles of IC, the median OS was 36.1 and 22.5 months in the early and late TRT subgroups, respectively (P = 0.009); the corresponding median PFS was 20.2 and 13.8 months, respectively (P = 0.038). In the patients who did not achieve CR or PR, no statistic difference was found in OS or PFS between the two subgroups.

CONCLUSION

Patients who received early TRT had more favorable outcomes than those who received late TRT. Patients who achieved CR or PR after two to three cycles of IC obtained more benefit from early TRT.

[Multi-factor retrospective study in 91 small cell lung cancer patients]

背景与目的

小细胞肺癌(small cell lung cancer, SCLC)约占新发肺癌的15%-25%, 尽管新型化疗药物及放疗技术不断进展, 但预后仍较差, 为进一步探讨局限期SCLC的预后因素, 回顾性评价不同TNM分期、不同治疗模式对局限期SCLC疗效及预后的影响。

方法

收集2006年1月-2012年3月期间吉林省肿瘤医院胸部肿瘤内科收治的资料完整经过序贯化放疗的局限期SCLC共91例, 根据2009年国际肺癌组织分期系统回顾性的将局限期患者分为Ⅰ期、Ⅱ期、Ⅲa期和Ⅲb期组, 比较4组的近期疗效、无进展生存期(progression-free survival, PFS)和生存期(overall survival, OS), 采用Kaplan-Meier法行生存分析, Cox比例风险模型行多因素回归分析。

结果

全组患者的RR率为93.4%;全组中位PFS 14.25个月, Ⅰ期、Ⅱ期、Ⅲa期、Ⅲb期的中位PFS分别为:22.03个月、15.97个月、11.99个月和10.5个月, 其中Ⅰ期和Ⅲa期、Ⅲb期的中位PFS有统计学差异(P < 0.05);中位OS为19.56个月, Ⅰ期、Ⅱ期、Ⅲa期、Ⅲb期的中位生存期分别为:30.38个月、22.07个月、16.0个月和15.25个月, 其中Ⅰ期、Ⅱ期和Ⅲa期、Ⅲb期的中位生存期有统计学差异(P < 0.05)。Ⅲa期和Ⅲb期病例早放疗与晚放疗比较, 晚放疗组生存期优于早放疗组, 并有统计学差异(P=0.011)。单因素分析表明TNM分期、放疗方式和放疗前化疗周期数是影响患者预后的主要因素。Cox分析表明TNM分期、PS评分、放疗前化疗周期数和放疗方式是影响总生存时间的独立预后因素。

结论

TNM分期是局限期SCLC的较好预后因素, 本研究显示Ⅲ期SCLC晚放疗有生存获益, 对于Ⅲa期和Ⅲb期局限期SCLC患者放疗时机的选择有待进一步研究, SCLC应用TNM分期更有利于指导治疗和预后。