Consolidation radiotherapy for patients with extended disease small cell lung cancer in a single tertiary institution: impact of dose and perspectives in the era of immunotherapy

Stanič, Karmen; Vrankar, Martina; But‐Hadžić, Jasna

doi:10.2478/raon-2020-0046

Cited by 4 publications

(4 citation statements)

References 40 publications

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“…In case of complete or partial response, consideration of TR is recommended, especially in patients with residual mediastinal tumors and low extra-thoracic metastatic burden. However, a survival benefit of consolidative TR after immunotherapy has been proposed [14,15] and seems worthwhile pursuing, as it would combine two treatments which have been shown to improve survival in this aggressive disease. Furthermore, the combination of radiotherapy and immunotherapy has proven both safe and beneficial regarding survival benefit in non-small cell lung cancer [16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…However, a survival benefit of consolidative TR after immunotherapy has been proposed [ 14 , 15 ] and seems worthwhile pursuing, as it would combine two treatments which have been shown to improve survival in this aggressive disease. Furthermore, the combination of radiotherapy and immunotherapy has proven both safe and beneficial regarding survival benefit in non-small cell lung cancer [ 16 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Is consolidative thoracic radiotherapy of extensive-stage small cell lung cancer still beneficial in the era of immunotherapy? A retrospective analysis

et al. 2023

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Purpose Extensive-stage small cell lung cancer (ES-SCLC) carries a dismal prognosis. The benefit of consolidative thoracic radiotherapy (TR) after first-line chemoimmunotherapy with PD-L1 inhibitors in this setting remains unclear. As TR can improve overall survival (OS) after conventional chemotherapy, we retrospectively analyzed OS of an inhouse cohort treated either with TR or with chemoimmunotherapy alone. Methods A total of 41 patients treated with chemoimmunotherapy with PD-L1 inhibitors (atezolizumab or durvalumab) for ES-SCLC at our hospital since 2019 were analyzed. TR was administered in 10 fractions of 3 Gy. Patient characteristics, number of immunotherapy cycles received, brain irradiation, and presence of hepatic and cerebral metastasis at diagnosis were assessed. Primary endpoint was OS after first diagnosis. Results Consolidative TR was associated with a significantly longer OS than systemic therapy alone (1-year OS 78.6% and 2‑year OS 37.1% vs. 1‑year OS 39.7% and 2 years not reached, p = 0.019). With regard to radiotherapy indication, survival at 1 year was 88.9% (log-rank p = 0.016) for patients receiving consolidative TR. For patients receiving TR in case of progression, 1‑year survival was 66.7%. Hepatic and cerebral metastasis at first diagnosis had no significant effect on OS. Conclusion TR was significantly associated with longer OS. The survival benefit of TR was most pronounced for consolidative radiotherapy after initial chemoimmunotherapy compared to TR in case of progression. Although retrospective findings need to be interpreted with caution, in the absence of prospective data, our findings provide a basis for offering consolidative TR in the era of chemoimmunotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is consolidative thoracic radiotherapy of extensive-stage small cell lung cancer still beneficial in the era of immunotherapy? A retrospective analysis

et al. 2023

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“… 10 , 11 The application of consolidation radiotherapy in selected patients with extensive-stage disease (ED) and a good initial response to chemotherapy have partly contributed to the improved survival rate, but application has been very inconsistent. 12 , 13 Immunotherapy has resulted in significant progress in the treatment of numerous malignant diseases, including non-small cell lung cancer (NSCLC). Expectations for the treatment of small cell lung cancer were high as well.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio can predict outcome in extensive-stage small cell lung cancer

Drpa

Šutić

Baranašić

et al. 2020

Radiology and Oncology

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BackgroundThe neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were analyzed in various carcinomas and their potential prognostic significance was determined. The objective of present study was to determine the correlation between these parameters and the survival of patients with small cell lung cancer (SCLC), since very few studies have been published on this type of carcinoma.Patients and methodsOne hundred and forty patients diagnosed with SCLC at University Hospital Center Zagreb, between 2012 and 2016 were retrospectively analyzed. Extensive-stage disease (ED) was verified in 80 patients and limited-stage disease (LD) in 60 patients. We analyzed the potential prognostic significance of various laboratory parameters, including NLR, PLR, and LMR, measured before the start of treatment.ResultsDisease extension, response to therapy, chest irradiation and prophylactic cranial irradiation (PCI), as well as hemoglobin, monocyte count, C-reactive protein (CRP), and lactate dehydrogenase (LDH) showed a prognostic significance in all patients. When we analyzed the patients separately, depending on the disease extension, we found that only skin metastases as well as LDH and NLR values, regardless of the cut-off value, had a prognostic significance in ED. Meanwhile, the ECOG performance status, chest irradiation, PCI, and hemoglobin and creatinine values had a prognostic significance in LD.ConclusionsNLR calculated before the start of the treatment had a prognostic significance for ED, while PLR and LMR had no prognostic significance in any of the analyzed groups of patients.

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“…Moreover, early RT especially within 6 cycles of chemotherapy prolong local recurrence-free survival (p = 0.001) and hyper-fractioned scheme (45 Gy in 30 fractions twice per day) has survival advantage over 60 Gy/30 fractions daily, which in line with Luan's finding [25]. However, Stanic et al concluded that higher dose resulted in better OS [26]. In our study, subgroup analysis showed no discrepancy of PFS and OS between BED > 60 Gy and < 60 Gy.…”

Section: Discussionmentioning

confidence: 67%

First-line atezolizumab/durvalumab plus platinum–etoposide combined with radiotherapy in extensive-stage small-cell lung cancer

Yang

Min

et al. 2023

BMC Cancer

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Background Immunotherapy has made significant advances in the treatment of extensive-stage small-cell lung cancer (ES-SCLC), but data in combination with radiotherapy are scarce. This study aims to assess the safety and efficacy of chemoimmunotherapy combined with thoracic radiotherapy in patients with ES-SCLC. Methods This single-center retrospective study analyzed patients with ES-SCLC who received standard platinum–etoposide chemotherapy combined with atezolizumab or durvalumab immunotherapy as induction treatment, followed by consolidative thoracic radiotherapy (CTRT) before disease progression in the first-line setting. Adverse events during radiotherapy with or without maintenance immunotherapy and survival outcomes were assessed. Results Between December 2019 and November 2021, 36 patients with ES-SCLC were identified to have received such treatment modality at one hospital. The number of metastatic sites at diagnosis was 1–4. The biological effective dose of CTRT ranged from 52 to 113 Gy. Only two patients (6%) developed grade 3 toxic effect of thrombocytopenia, but none experienced grade 4 or 5 toxicity. Four patients developed immune-related pneumonitis during the induction treatment period but successfully completed later CTRT. The rate of radiation-related pneumonitis was 8% with grades 1–2 and well tolerated. The median progression-free survival (PFS) was 12.8 months, but the median overall survival (OS) was not determined. The estimated 1-year OS was 80.2% and 1-year PFS was 53.4%. Conclusions Immunotherapy combined with CTRT for ES-SCLC is safe and has ample survival benefit.

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Consolidation radiotherapy for patients with extended disease small cell lung cancer in a single tertiary institution: impact of dose and perspectives in the era of immunotherapy

Cited by 4 publications

References 40 publications

Is consolidative thoracic radiotherapy of extensive-stage small cell lung cancer still beneficial in the era of immunotherapy? A retrospective analysis

Is consolidative thoracic radiotherapy of extensive-stage small cell lung cancer still beneficial in the era of immunotherapy? A retrospective analysis

Neutrophil-to-lymphocyte ratio can predict outcome in extensive-stage small cell lung cancer

First-line atezolizumab/durvalumab plus platinum–etoposide combined with radiotherapy in extensive-stage small-cell lung cancer

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