Skip to main content
SpringerLink
Log in

Chemoradiotherapy duration correlates with overall survival in limited disease SCLC patients with poor initial performance status who successfully completed multimodality treatment

Dauer der Chemoradiotherapie korreliert mit Gesamtüberleben bei erfolgreich multimodal therapierten SCLC-Patienten im Stadium „limited disease“ mit initial schlechtem Performance-Status

  • Original article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background and purpose

Limited data concerning treatment-related prognostic factors in limited disease (LD) small-cell lung cancer (SCLC) patients with poor initial performance status (PS) who successfully completed chemoradiotherapy (CRT) are available.

Patients and methods

A total of 125 patients with initial PS WHO 2–3 who successfully completed CRT were retrospectively reviewed. Thoracic radiation therapy (TRT) was applied in the concurrent (group 1) or sequential (group 2) mode. Influence of treatment type, time from diagnosis to start of TRT, number of chemotherapy cycles, prophylactic cranial irradiation (PCI), occurrence of brain metastases (BMs), and duration of CRT on overall survival (OS) were analyzed.

Results

Median duration of CRT was 156 days in group 1 and 195 days in group 2 (p < 0.001). Median progression-free survival and OS were 11.6 (95% confidence interval (CI) 10–13.2) and 14.9 (95% CI 11.7–17.6) months with no difference between the groups. The 2- and 3-year survival rates were 37.9 ± 6.9% and 22.7 ± 6.3% in group 1 and 22.4 ± 4.9% and 15.2 ± 4.3% in group 2, respectively. Duration of CRT was only treatment-related factor predicting OS in the uni- (p < 0.014) and multivariate (p < 0.025) analyses. Short dose-dense CRT was associated with improved OS.

Conclusion

Duration of CRT affects OS in LD SCLC patients with poor initial performance status who successfully completed multimodality treatment.

Zusammenfassung

Hintergrund und Ziel

Es liegen wenige Daten über behandlungsrelevante prognostische Faktoren von Patienten mit kleinzelligem Bronchialkarzinom (SCLC) im Stadium „Limited Disease“ (LD) mit initial schlechtem Performance-Status (PS) nach erfolgreich abgeschlossener multimodaler Therapie (CRT) vor.

Patienten und Methoden Hintergrund und Ziel

Die retrospektive Studie berücksichtigt 125 Patienten mit PS WHO 2–3, bei denen eine Chemoradiotherapie (CRT) erfolgreich abgeschlossen werden konnte (Tab. 1). Eine Strahlentherapie des Thorax (TRT) wurde simultan (Gruppe 1) oder sequentiell (Gruppe 2) zur Chemotherapie durchgeführt. Die Analyse der Gesamtüberlebensrate (OS) basiert auf dem Einfluss der Behandlungsart der CRT, der Zeit von der Diagnose bis zum Beginn der TRT, der Anzahl der Chemotherapie-Zyklen, der prophylaktischen Bestrahlung des Kopfes, dem Auftreten von Hirnmetastasen und der Dauer der CRT.

Ergebnisse

Die mittlere Dauer der CRT betrug 156 Tage in Gruppe 1 und 195 Tage in Gruppe 2 (p < 0,001; Tab. 3). Das mittlere progressionsfreie Überleben bzw. das OS betrug 11,6 Monate (95%-KI: 10–13,2) bzw. 14,9 Monate (95%-KI: 11,7–17,6) ohne statistischen Unterschied zwischen den Untersuchungsgruppen (Abb. 2, Abb. 3). Die 2- bzw. 3-Jahres-Überlebensrate betrug 37,9 ± 6,9% bzw. 22,7 ± 6,3% in Gruppe 1 und 22,4 ± 4,9% bzw. 15,2 ± 4,3% in Gruppe 2 (Tab. 2). Einziger behandlungsrelevanter Faktor war die Dauer der CRT, welche mit dem OS in der univariaten (p < 0,014) und multivariaten Analyse (p < 0,025) korrelierte (Tab. 4). Eine kurze dosisdichte CRT war somit mit einem besseren Gesamtüberleben assoziiert.

Zusammenfassung

Die Dauer der CRT beeinflusst das OS bei LD-SCLC-Patienten mit initial schlechtem PS nach erfolgreich abgeschlossener multimodaler Therapie.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Auperin A, Arriagada R, Pignon JP et al (1999) Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic cranial irradiation overview collaborative group. N Engl J Med 12:476–484

    Article  Google Scholar 

  2. Chen J, Jiang R, Garces Y et al (2010) Prognostic factors for limited-stage small cell lung cancer: a study of 284 patients. Lung Cancer 67:221–226

    Article  PubMed  Google Scholar 

  3. De Ruysscher D, Pijls-Johannesma M, Vansteenkiste J et al (2006) Systematic review and meta-analysis of randomized, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer. Ann Oncol 17:543–552

    Article  Google Scholar 

  4. De Ruysscher D, Pijls-Johannesma M, Bentzen SM et al (2006) Time between the first day of chemotherapy and last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 24:1057–1063

    Article  Google Scholar 

  5. Fietkau R, Sauer R (2002) Die frühzeitige Radiotherapie im Rahmen der radiochemotherapie des kleinzelligen Bronchialkarzinoms ist im Stadium “Limited Disease” der späten Bestrahlung überlegen. Strahlenther Onkol 178:585–588

    PubMed  Google Scholar 

  6. Fried DB, Morris DE, Poole C et al (2004) Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer. J Clin Oncol 22:4837–4845

    Article  PubMed  Google Scholar 

  7. Früh M, Kacsir B, Ess S et al (2011) Extrapulmonary small cell carcinoma: an indication for prophylactic cranial irradiation? A single center experience. Strahlenther Onkol 187:561–567

    Article  PubMed  Google Scholar 

  8. Gregor A, Drings P, Rinaldi M et al (1995) Acute toxicity of alternating schedule of chemotherapy and irradiation in limited small-cell lung cancer in a pilot study (08877) of the EORTC Lung Cancer Cooperative Group. Ann Oncol 6:403–405 (letter)

    PubMed  CAS  Google Scholar 

  9. Gregor A, Drings P, Burghouts J et al (1997) Randomized trial of alternating versus sequential radiotherapy/chemotherapy in limited-disease patients with small-cell lung cancer: a European Organisation for Research and Treatment of Cancer Lung Cancer Cooperative Group study. J Clin Oncol 15:2840–2847

    PubMed  CAS  Google Scholar 

  10. Ichinose Y, Hara N, Ohta M et al (1989) Brain metastases in patients with limited small cell lung cancer achieving complete remission. Correlation with TNM Staging. Chest 96:1332–1335

    Article  PubMed  CAS  Google Scholar 

  11. Jeremic B, Shibamoto Y, Acimovic L, Milisavljevic S (1997) Initial versus delayed accelerated hyperfractionated radiation therapy and concurrent chemotherapy in limited small cell lung cancer. J Clin Oncol 15:893–900

    PubMed  CAS  Google Scholar 

  12. Klautke G, Sauer R, Fietkau R (2008) Combined treatment modality in small cell lung cancer. The impact of radiotherapy on survival. Strahlenther Onkol 184:61–66

    Article  PubMed  Google Scholar 

  13. Klautke G, Fahndrich S, Semrau S et al (2006) Simultaneous chemoradiotherapy with irinotecan and cisplatin in limited disease small cell lung cancer: a phase I study. Lung Cancer 53:183–188

    Article  PubMed  Google Scholar 

  14. Manapov F, Klautke G, Fietkau R (2008) Prevalence of brain metastases immediately before prophylactic cranial irradiation in limited disease small cell lung cancer patients with complete remission to chemoradiotherapy: a single institution experience. J Thorac Oncol 3:652–655

    Article  PubMed  Google Scholar 

  15. Manapov F (2009) Central nervous system relapse continues to be a therapeutic challenge in extensive disease small-cell lung cancer patients with initial symptomatic brain metastases and good response to chemoradiotherapy. J Neurooncol 98:349–355

    Article  PubMed  Google Scholar 

  16. Matsumoto Y, Mari S, Makoto S et al (2003) Chemoradiotherapy for limited disease small cell lung cancer. Niigata Kenritsu Byoin Iggakkaishi 51:6–13

    Google Scholar 

  17. Miller KL, Marks LB, Sibley GS et al (2003) Routine use of approximately 60 Gy once- daily thoracic irradiation for patients with limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 56:355–359

    Article  PubMed  Google Scholar 

  18. Movsas B, Moughan J, Komaki R et al (2003) Radiotherapy patterns of care study in lung carcinoma. J Clin Oncol 21:4553–4559

    Article  PubMed  CAS  Google Scholar 

  19. Murray N, Coy P, Pater JL et al (1993) Importance of timing for thoracic irradiation in the combined modality treatment of limited stage small-cell lung cancer. J Clin Oncol 11:336–344

    PubMed  CAS  Google Scholar 

  20. Pignon JP, Ariagada R, Ihde DC et al (1992) A meta-analysis of thoracic radiotherapy for small cell lung cancer. N Engl J Med 327:1618–1624

    Article  PubMed  CAS  Google Scholar 

  21. Pijls -Johannesma MCG, De Ruysscher D, Lambin P et al (2004) Early versus late chest radiotherapy for limited stage small-cell lung cancer. Cochrane Database Syst Rev:CD004700

    Google Scholar 

  22. Rades D, Nadrowitz R, Buchmann I et al (2010) Radiolabeled cetuximab plus whole-brain irradiation (WBI) for the treatment of brain metastases from non-small cell lung cancer (NSCLC). Strahlenther Onkol 186:458–462

    Article  PubMed  Google Scholar 

  23. Roeder F, Friedrich J, Timke C et al (2010) Correlation of patient-related factors and dose-volume histogramm parameters with the onset of radiation pneumonitis in patients with small cell lung cancer. Strahlenther Onkol 186:149–156

    Article  PubMed  Google Scholar 

  24. Sas-Korczyńska B, Korzeniowski S, Wójcik E (2010) Comparison of the effectiveness of “late” and “early” prophylactic cranial irradiation in patients with limited-stage small cell lung cancer. Strahlenther Onkol 186:315–319

    Article  PubMed  Google Scholar 

  25. Schnabel T, Schmitt G (1993) The role of radiotherapy in the management of small cell lung cancer (SCLC). Strahlenther Onkol 169:329–338

    PubMed  CAS  Google Scholar 

  26. Seute T, Leffers P, Wilmink JT et al (2006) Response of asymptomatic brain metastases from small-cell lung cancer to systemic first -line chemotherapy. J Clin Oncol 24:2079–2083

    Article  PubMed  CAS  Google Scholar 

  27. Skarlos DV, Samantas E, Briassoulis E et al (2001) Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: a randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG). Ann Oncol 12:1231–1238

    Article  PubMed  CAS  Google Scholar 

  28. Spiro SG, James LE, Rudd RM et al (2006) Early compared with late radiotherapy in combined modality treatment for limited disease cancer: a London Lung Cancer Group multicenter randomized clinical trial and meta-analysis. J Clin Oncol 24:3823–3829

    Article  PubMed  CAS  Google Scholar 

  29. Takada M, Fukuoka M, Kawahara M et al (2002) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 20:3054–3060

    Article  PubMed  CAS  Google Scholar 

  30. Tomita N, Kodaira T, Hida T et al (2010) The impact of radiation dose and fractionation on outcomes for limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 76:1121–1126

    Article  PubMed  Google Scholar 

  31. 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 340:265–271

    Article  PubMed  CAS  Google Scholar 

  32. Videtic GM, Truong PT, Ash RB et al (2005) Does sex influence the impact that smoking, treatment interruption and impaired pulmonary function have on outcomes in limited stage small cell lung cancer treatment? Can Respir J 12:245–250

    PubMed  Google Scholar 

  33. Warde P, Payne D (1992) Does thoracic irradiation improve survival and local control in limited stage small cell carcinoma of the lung? A meta-analysis. J Clin Oncol 10:890–895

    PubMed  CAS  Google Scholar 

  34. Work E, Nielsen OS, Bentzen SM et al (1997) Randomized study of initial versus late chest irradiation combined with chemotherapy in limited-stage small-cell lung cancer. J Clin Oncol 15:3030–3037

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Marchioninistra.15, 81377, Munich, Germany

    F. Manapov, M Niyazi & C. Belka

  2. Clinical Tumorregister, Department of Radiation Oncology, University of Rostock, Rostock, Germany

    S. Klöcking

  3. Department of Radiation Oncology, University of Rostock, Rostock, Gemany

    F. Manapov, G. Hildebrandt, R. Fietkau & G. Klautke

  4. Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany

    R. Fietkau & G. Klautke

Authors
  1. F. Manapov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Klöcking
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Niyazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Belka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Hildebrandt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Fietkau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Klautke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Manapov.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Manapov, F., Klöcking, S., Niyazi, M. et al. Chemoradiotherapy duration correlates with overall survival in limited disease SCLC patients with poor initial performance status who successfully completed multimodality treatment. Strahlenther Onkol 188, 29–34 (2012). https://doi.org/10.1007/s00066-011-0016-9

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-011-0016-9

Keywords

Schlüsselwörter

Search

Navigation