Abstract
Purpose
This study was designed to review outcomes of once- (QD) versus twice-daily (BID) radiotherapy (RT) for limited stage small-cell lung cancer (L-SCLC) treated at Dana-Farber Cancer Institute/Brigham and Women’s Hospital.
Methods
We reviewed records for all patients with L-SCLC treated with radical chemoradiotherapy at our institution between January 2005 and December 2010. Differences in patient, tumor, and treatment characteristics were assessed by Student’s t test and Fisher exact test. Outcomes were compared using Kaplan–Meier estimates and Cox proportional hazards regression.
Results
Twenty patients received QD RT to a median dose of 61.2 Gy, and 26 patients received BID RT to a dose of 45 Gy. Median follow-up was 2.8 years. Overall survival (OS) was similar in both groups. 5-year locoregional control (LC) for all patients was 67 %: 80 % for the QD group and 57 % for the BID group (log-rank, P = 0.16). Grade 2 or higher dermatitis and pneumonitis were significantly higher in the QD group (15 vs. 0 %, P = 0.0014 and 13 vs. 4 %, P = 0.048, respectively), whereas Grade 2 or higher esophagitis trended higher in the BID group (44 vs. 24 %, P = 0.076).
Conclusions
Although there were no differences in OS with QD versus BID RT, there was a trend toward increased LC in the QD group. Dermatitis and pneumonitis were more common for QD RT, and esophagitis was somewhat more common for BID RT. Possible differences in toxicities depending on RT regimen may be worth further investigation, until results from CALGB 30610 become available.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Cancer Society (2012) Cancer facts and figures 2012. American Cancer Society, Atlanta
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 24:4539–4544
Pignon JP, Arriagada R, Ihde DC et al (1992) A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 327:1618–1624
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
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
Choi NC, Herndon JE II, Rosenman J et al (1998) Phase I study to determine the maximum-tolerated dose of radiation in standard daily and hyperfractionated-accelerated twice-daily radiation schedules with concurrent chemotherapy for limited-stage small-cell lung cancer. J Clin Oncol 16:3528–3536
Bogart JA, Herndon JE II, Lyss AP et al (2004) 70 Gy thoracic radiotherapy is feasible concurrent with chemotherapy for limited-stage small-cell lung cancer: analysis of Cancer and Leukemia Group B study 39808. Int J Radiat Oncol Biol Phys 59(2):460–468
Movsas B, Moughan J, Komaki R (2002) Radiotherapy (RT) patterns of care study (PCS) in lung carcinoma [Abstract]. Int J Radiat Oncol Biol Phys 54(Suppl 1):101
NCI Clinical Trials (PDQ) Phase III randomized study of three different thoracic radiotherapy regimens in patients with limited-stage small cell lung cancer receiving cisplatin and etoposide [Internet]. http://www.cancer.gov/clinicaltrials/search/view?cdrid=588879&version=healthprofessional Accessed 22 August 2012
Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655
Detterbeck FC, Boffa DJ, Tanoue LT (2009) The new lung cancer staging system. Chest 136(1):260–271
NCI Common Terminology Criteria for Adverse Events (CTCAE) v.4 data files [Internet]. http://evs.nci.nih.gov/ftp1/CTCAE/About.html Accessed 17 May 2010
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247
Machtay M, Bae K, Movsas B et al (2012) Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation: an analysis of the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 82(1):425–434
Mauguen A, Le Pechoux C, Saunders MI et al (2012) Hyperfractionated or accelerated radiotherapy in lung cancer; an individual patient data meta-analysis. J Clin Oncol 30(22):2788–2797
Tsujino K, Hirota S, Kotani Y et al (2006) Radiation pneumonitis following concurrent accelerated hyperfractionated radiotherapy and chemotherapy for limited-stage small-cell lung cancer: dose-volume histogram analysis and comparison with conventional chemoradiation. Int J Radiat Oncol Biol Phys 64(4):1100–1105
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(4):1121–1126
Roach M 3rd, Gandara DR, Yuo HS et al (1995) Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors. J Clin Oncol 13(10):2606–2612
Acknowledgments
This work was supported by internal funds of the Department of Radiation Oncology at the Dana-Farber Cancer Institute/Brigham and Women’s Hospital.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gazula, A., Baldini, E.H., Chen, A. et al. Comparison of Once and Twice Daily Radiotherapy for Limited Stage Small-Cell Lung Cancer. Lung 192, 151–158 (2014). https://doi.org/10.1007/s00408-013-9518-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-013-9518-9