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Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer

A single-centre retrospective study

Analyse der Risikofaktoren für pulmonale Komplikationen bei Patienten mit kleinzelligem Lungenkrebs im limitierten Stadium

Eine monozentrische retrospektive Untersuchung

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Abstract

Introduction

The most effective therapy in patients with limited-stage small cell lung cancer (LS SCLC) seems to be chemotherapy (using platinum-based regimens) and thoracic radiotherapy (TRT), which is followed by prophylactic cranial irradiation.

Materials and methods

The analysed group comprised 217 patients who received combined treatment for LS SCLC, i.e. chemotherapy (according to cisplatin and etoposide schedule) and TRT (concurrent in 101 and sequential in 116 patients). The influence of chemoradiotherapy (ChT-RT) schedule on treatment results (frequency of complete response, survival rates, and incidence of treatment failure and complications) was evaluated, and the frequency and severity of pulmonary complications were analysed to identify risk factors.

Results

The 5‑year survival rates in concurrent vs. sequential ChT-RT schedules were 27.3 vs. 11.7% (overall) and 28 vs. 14.3% (disease-free). The frequencies of adverse events in relation to concurrent vs. sequential therapy were 85.1 vs. 9.5% (haematological complications) and 58.4 vs. 38.8% (pulmonary fibrosis), respectively. It was found that concurrent ChT-RT (hazard ratio, HR 2.75), a total dose equal to or more than 54 Gy (HR 2.55), the presence of haematological complications (HR 1.89) and a lung volume receiving a dose equal to or greater than 20 Gy exceeding 31% (HR 1.06) were the risk factors for pulmonary complications.

Conclusion

Pulmonary complications after ChT-RT developed in 82% of patients treated for LS SCLC. In comparison to the sequential approach, concurrent ChT-RT had a positive effect on treatment outcome. However, this is a factor that can impair treatment tolerance, which manifests in the appearance of side effects.

Zusammenfassung

Einführung

Die wirksamste Therapie bei einem kleinzelligen Lungenkrebs im limitierten Stadium (LS SCLC) scheinen Chemotherapie (platinbasierte Regime) und thorakale Strahlentherapie (TRT) zu sein, begleitet von der prophylaktischen Schädelbestrahlung.

Materialien und Methoden

Analysiert wurden 217 Patienten, die eine kombinierte Behandlung des LS SCLC erhalten haben: Chemotherapie (nach Cisplatin- und Etoposid-Schema) und TRT (gleichzeitig bei 101 und sequentiell bei 116 Patienten). Der Einfluss des Schemas der Chemo-Strahlentherapie (ChT-RT) auf die Behandlungsergebnisse (Häufigkeit von vollständiger Reaktion, Therapieversagen und Komplikationen und Überlebensrate) wurde bewertet und die Häufigkeit und Schwere der pulmonalen Komplikationen analysiert, um diese als Risikofaktoren zu identifizieren.

Ergebnisse

Die 5‑Jahres-Überlebensraten bei gleichzeitigem vs. sequentiellem ChT-RT-Schema lag bei 27,3 % vs. 11,7 % (gesamt) bzw. 28 % vs. 14,3 % (krankheitsfrei). Die Häufigkeit von Nebenwirkungen in Bezug auf gleichzeitige vs. sequenzielle Therapie lag bei 85,1 % vs. 9,5 % (hämatologische Komplikationen) und 58,4 % vs. 38,8 % (Lungenfibrose). Die gleichzeitige ChT-RT (Hazard Ratio [HR] 2,75), eine Gesamtdosis gleich oder mehr als 54 Gy (HR 2,55), die Anwesenheit von hämatologischen Komplikationen (HR 1,89) und das Lungenvolumen, welches die Dosis gleich oder größer als 20 Gy enthielt, machten mehr als 31 % (HR 1,06) der Risikofaktoren für pulmonale Komplikationen aus.

Schlussfolgerung

Pulmonale Komplikationen nach ChT-RT traten bei 82 % der wegen LS SCLC behandelten Patienten auf. Die gleichzeitige ChT-RT hatte im Vergleich zum sequentiellem Ansatz eine positive Wirkung auf das Behandlungsergebnis und ist ein Faktor, der die Behandlungstoleranz beeinträchtigen kann, was sich im Auftreten von Nebenwirkungen äußert.

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Authors and Affiliations

  1. Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland

    Beata Sas-Korczyńska MD, PhD & Wojciech Kamzol

  2. Department of Diagnostic Radiology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland

    Elżbieta Łuczyńska

  3. Department of Statistics, Cracow University of Economics, Rakowicka 27, 31-510, Cracow, Poland

    Andrzej Sokołowski

Authors
  1. Beata Sas-Korczyńska MD, PhD
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  3. Wojciech Kamzol
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Corresponding author

Correspondence to Beata Sas-Korczyńska MD, PhD.

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Conflict of interest

B. Sas-Korczyńska, E. Łuczyńska, W. Kamzol and A. Sokołowski declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Sas-Korczyńska, B., Łuczyńska, E., Kamzol, W. et al. Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer. Strahlenther Onkol 193, 141–149 (2017). https://doi.org/10.1007/s00066-016-1069-6

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  • DOI: https://doi.org/10.1007/s00066-016-1069-6

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