Advertisement

Metastatic location of extensive stage small-cell lung cancer: implications for thoracic radiation

  • Huaqi Zhang
  • Lei Deng
  • Xin Wang
  • Duoying Wang
  • Feifei TengEmail author
  • Jinming YuEmail author
Original Article – Clinical Oncology
  • 15 Downloads

Abstract

Backgrounds

This study was designed to evaluate the role of thoracic radiotherapy (TRT) in a selected patient population with oligometastatic extensive stage small-cell lung cancer (ES-SCLC) without brain or liver involved. The underlying hypothesis was that TRT will improve outcomes in this favorable patient population.

Methods

305 patients were included in an institutional review board (IRB)-approved study, of which 105 received TRT after chemotherapy (ChT) and 200 received ChT alone. The survival outcomes were compared between ChT+TRT group and ChT-alone group in patients with oligometastasis without brain or liver involved and patients with brain/liver/multimetastasis, respectively.

Results

The 1-year, 2-year and 5-year overall survival (OS) for all patients were 60.3%, 23.9% and 1.6%, respectively. The addition of TRT significantly improved PFS in total patients than ChT alone (14.5 months vs. 10.1 months, p = 0.006), but the OS benefit was not significant (17.8 months vs. 16.5 months, p = 0.061). For patients with oligometastasis (n = 118), TRT offered significant progression free survival (PFS) (16.5 months vs. 9.1 months, p = 0.005) and OS (19.2 months vs. 15.6 months, p = 0.039) benefits. However, for patients with brain/liver/multimetastasis, the PFS and OS were not improved with TRT (p = 0.49, p = 0.811).

Conclusions

TRT provided significant PFS and OS benefits in patients with oligometastatic ES-SCLC without brain or liver involved. The consolidative TRT is a reasonable treatment option for this favorable patient population.

Keywords

Extensive stage small-cell lung cancer Thoracic radiation Metastatic location Oligometastasis Prognosis 

Notes

Author contribution

FFT and JMY designed the study; HQZ, LD, XW, DYW collected and analyzed data; HQZ and FFT drafted the article.

Funding

This work was supported by Grants from the National Natural Science Foundation of China (NSFC 81803066).

Compliance with ethical standards

Conflict of interest

The authors have no disclosures.

Ethical approval

The study has been reviewed and approved by the Ethics Committee of Shandong Cancer Hospital and Institute, China. Either a signed informed consent or authorisation from the National Supervisory for Welfare and Health was obtained for all patients. This study has been conducted according to the Declaration of Helsinki.

References

  1. Ashworth A, Rodrigues G, Boldt G, Palma D (2013) Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer 82:197–203CrossRefGoogle Scholar
  2. Cai H, Wang H, Li Z, Lin J, Yu J (2018) The prognostic analysis of different metastatic patterns in extensive-stage small-cell lung cancer patients: a large population-based study. Future Oncol 14:1397–1407CrossRefGoogle Scholar
  3. Clinical Trials (2016) Phase III comparison of thoracic radiotherapy regimens in patients with limited small cell lung cancer also receiving cisplatin and etoposide. ClinicalTrials.gov, ‘‘Search for Clinical Trials’,’ 13 November 2016, http://www.clinicaltrials.gov
  4. Faivre-Finn C, Snee M, Ashcroft L et al (2017) Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol 18:1116–1125CrossRefGoogle Scholar
  5. Fruh M, De Ruysscher D, Popat S et al (2013) Small-cell lung cancer (SCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 24(Suppl 6):99–105CrossRefGoogle Scholar
  6. Gore EM, Hu C, Sun AY et al (2017) Randomized phase ii study comparing prophylactic cranial irradiation alone to prophylactic cranial irradiation and consolidative extracranial irradiation for extensive-disease small cell lung cancer (ED SCLC): NRG oncology RTOG 0937. J Thorac Oncol 12:1561–1570CrossRefGoogle Scholar
  7. Govindan R, Page N, Morgensztern D et al (2006) Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol 24:4539–4544CrossRefGoogle Scholar
  8. Hanna N, Bunn PA Jr, Langer C et al (2006) Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. J Clin Oncol 24:2038–2043CrossRefGoogle Scholar
  9. Jeremic B, Shibamoto Y, Nikolic N et al (1999) Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: a randomized study. J Clin Oncol 17:2092–2099CrossRefGoogle Scholar
  10. Kalemkerian GP (2015) Running in Place: the 20th anniversary of the NCCN small cell lung cancer guidelines panel. J Natl Compr Cancer Netw 13:704–706CrossRefGoogle Scholar
  11. Li-Ming X, Zhao LJ, Simone CB 2nd et al (2017) Receipt of thoracic radiation therapy and radiotherapy dose are correlated with outcomes in a retrospective study of three hundred and six patients with extensive stage small-cell lung cancer. Radiother Oncol 125:331–337CrossRefGoogle Scholar
  12. Micke P, Faldum A, Metz T et al (2002) Staging small cell lung cancer: veterans administration lung study group versus international association for the study of lung cancer–what limits limited disease? Lung Cancer 37:271–276CrossRefGoogle Scholar
  13. NCCN guidelines version (2019) 2019 small cell lung cancer. https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed 13 Aug 2019
  14. Ou SH, Ziogas A, Zell JA (2009) Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. J Thorac Oncol 4:37–43CrossRefGoogle Scholar
  15. Palma DA, Warner A, Louie AV, Senan S, Slotman B, Rodrigues GB (2016) Thoracic radiotherapy for extensive stage small-cell lung cancer: a meta-analysis. Clin Lung Cancer 17:239–244CrossRefGoogle Scholar
  16. Rathod S, Jeremic B, Dubey A et al (2019) Role of thoracic consolidation radiation in extensive stage small cell lung cancer: a systematic review and meta-analysis of randomised controlled trials. Eur J Cancer 110:110–119CrossRefGoogle Scholar
  17. Siegel RL, Miller KD, Jemal A (2017) Cancer Statistics, 2017. CA Cancer J Clin 67:7–30CrossRefGoogle Scholar
  18. Slotman BJ, van Tinteren H, Praag JO et al (2015) Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 385:36–42CrossRefGoogle Scholar
  19. Stahel RA (1991) Diagnosis, staging, and prognostic factors of small cell lung cancer. Curr Opin Oncol 3:306–311CrossRefGoogle Scholar
  20. Turrisi AT 3rd, Kim K, Blum R et al (1999) Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340:265–271CrossRefGoogle Scholar
  21. Yao JC, Hassan M, Phan A et al (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyTianjin Medical UniversityTianjinChina
  2. 2.Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
  3. 3.Shandong Adverse Drug Reaction Monitoring CenterJinanChina
  4. 4.Antai Plasma Collection StationJinanChina

Personalised recommendations