Lung cancer is the major cancer killer in the Western world, with the small cell lung cancer (SCLC) representing around 15–20% of all lung cancers. Extensive disease small cell lung cancer (ED SCLC) is found in approximately two-thirds of all cases, composed of both metastatic (M1) and non-metastatic (but presumably with tumor burden too large for locoregional-only approach) variant. Standard treatment options involve chemotherapy (CHT) over the past several decades. Radiation therapy (RT) had mostly been used in palliation of locoregional and/or metastatic disease. In contrast to its established role in treating metastatic disease, thoracic RT (TRT) had never been established as important part of the treatment aspects in this setting. In the past two decades, thoracic oncologists have witnessed wide introduction of modern RT and CHT aspects in ED SCLC, which led to more frequent use of RT and rise in the number of clinical studies. Since the pivotal study of Jeremic et al., who were the first to show importance of TRT in ED SCLC, a number of single-institutional studies have reconfirmed this observation, while recent prospective randomized trials (CREST and RTOG 0937) brought more substance to this issue. Similarly, the issue of prophylactic cranial irradiation was investigated in EORTC and the Japanese study, respectively, bringing somewhat conflicting results and calling for additional research in this setting. Future studies in ED SCLC could incorporate questions of RT dose and fractionation as well as the number of CHT cycles and type of combined Rt-CHT (sequential vs concurrent).

Simplified GTV (sGTV) was calculated by oval volume formula. We confirmed statistically significant association between sGTV and standard GTV as previous preparation. Metastatic nodal extent was divided into limited nodal extent (ND2a) (defined as "LN") or extensive nodal extent (>ND2a)(defined as "EN"). Prognostic impact of sGTV and metastatic nodal extent was evaluated by univariate and multivariate analysis. Result: 58 patients were enrolled in this study. Median progression-free survival (PFS) of all patients were 9.0 months. In univariate analysis, patients with sGTV>90cm 3 had shorter PFS compared to those with sGTV90cm 3 (median PFS: 6.7 vs. 11.7, p¼0.03). Further, patients with sGTV>90cm 3 and EN showed poorer PFS (HR 3.3; 95% CI,1.40-7.87; p<0.01) and OS (HR 3.3, 95% CI: 1.18-9.32, p<0.01) in univariate analysis. Multivariate analysis also showed an independent poor prognosis in patients with sGTV>90cm 3 and EN (adjusted HR of PFS: 3.6, 95% CI: 1.49-8.71, p<0.01, adjusted HR of OS 4.1, 95% CI: 1.37-12.6, p¼0.01). Conclusion: Combined evaluation using sGTV and metastatic nodal extent can be a useful stratified factor for clinical trial in patients with stage III NSCLC.

No abstract

No abstract

No abstract