Does the response to induction chemotherapy impact the timing of thoracic radiotherapy for limited‐stage small‐cell lung cancer?

Wang, Peng; Liu, Weishuai; Zhao, Lujun; Wang, Ping

doi:10.1111/1759-7714.12229

Cited by 6 publications

(6 citation statements)

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“…Patients in the TRT group were stratified by the number of induction chemotherapy cycles they received prior to TRT. According to the previous research [ 15 ], we defined ERT as receiving TRT before or at the third cycle of chemotherapy, LRT was receiving TRT after the third cycle of chemotherapy. Specifically, the ERT group (≤3 cycles, n = 65) and the LRT group (>3 cycles, n = 122).…”

Section: Methodsmentioning

confidence: 99%

Timing of thoracic radiotherapy in the treatment of extensive-stage small-cell lung cancer: important or not?

Luo

Zhao

et al. 2017

Radiat Oncol

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BackgroundThis study evaluated the prognosis of patients with extensive-stage small-cell lung cancer (ES-SCLC) that may be associated with timing of thoracic radiotherapy (TRT).MethodsES-SCLC patients (n = 232) without progression were retrospectively analyzed after first-line induction chemotherapy. Patients in the TRT group were stratified as early-TRT (ERT; ≤3 cycles of induction chemotherapy received prior to TRT, n = 65) or late-TRT (LRT; >3 cycles, n = 122). To avoid selection bias, we conducted Propensity Score Matching (PSM) for patients. Overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS) were assessed and compared.ResultsOverall, the median survival time, PFS, and LRRFS were 13.2, 8.7, and 14.6 months, respectively. After matching by PSM, there were 45 patients total in the TRT/non-TRT groups, and 56 patients total in the ERT/LRT groups. OS, PFS, and LRRFS were significantly longer in the TRT group than the non-TRT group (P < 0.001, all). However, between the ERT and LRT groups these survival parameters were similar (P > 0.05, all).ConclusionFor ES-SCLC patients without progression, the addition of TRT after first-line chemotherapy benefited survival greatly. Early TRT showed no significant benefit over late TRT.

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Section: Methodsmentioning

confidence: 99%

Timing of thoracic radiotherapy in the treatment of extensive-stage small-cell lung cancer: important or not?

Luo

Zhao

et al. 2017

Radiat Oncol

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“…A total of 4,212 records were searched, and 40 records were screened to quality assessment. Among the 40 records, 3 records (40,49,50) were excluded for high risk of bias and 37 records, consisting of 15 phase III RCTs (4, 5, 13-25), 12 phase II (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), and 10 retrospective studies (39,(41)(42)(43)(44)(45)(46)(47)(48)51), were finally included for analysis (Supplementary Figure 1). Long-term survival data of three single-arm phase II studies (35)(36)(37) were updated in another report (52).…”

Section: Study Characteristicsmentioning

confidence: 99%

Progression-Free Survival and Time to Progression as Potential Surrogate Endpoints for Overall Survival in Chemoradiotherapy Trials in Limited-Stage Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Yang

Wang

et al. 2022

Front. Oncol.

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PurposeTo investigate whether progression-free survival (PFS) or time to progression (TTP) could be a valid surrogate endpoint for overall survival (OS) in patients with limited-stage small-cell lung cancer (LS-SCLC) receiving combined chemoradiotherapy.MethodsLiterature searching was performed in PubMed, Embase, and The Cochrane Library up to 2021. Prediction models were firstly established using data from phase III randomized controlled trials (RCTs) and then externally validated in phase II and retrospective studies. Correlation analysis was evaluated by a weighted linear regression model at both trial and arm levels. Cross-validation was performed to assess the consistency and robustness of the established models.Results37 studies, including 15 phase III RCTs, 12 phase II studies, and 10 retrospective studies, were selected in the final analysis. In trial-level surrogacy, a very good correlation was observed between hazard ratios (HRs) of PFS/TTP and OS (R2 = 0.783, 95% CI 0.771–0.794). In arm-level surrogacy, very good correlations were also observed between 2-year (R2 = 0.823, 95% CI 0.814–0.832), 3-year (R2 = 0.843, 95% CI 0.833–0.850), 5-year (R2 = 0.852, 95% CI 0.843–0.859) PFS/TTP, and 5-year OS. An excellent correlation was observed between 4-year PFS/TTP and 5-year OS (R2 = 0.906, 95% CI 0.901–0.910). Cross-validation demonstrated reasonable overall consistency. External validation in phase II and retrospective studies showed good agreement (R2, 0.728–0.824).ConclusionsPFS/TTP was a valid surrogate endpoint for OS in patients with LS-SCLC receiving combined chemoradiotherapy. The finding provides high-level evidence to support PFS/TTP as the primary endpoint in clinical trials so as to speed up introducing novel agents to the treatment of LS-SCLC.

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“…For LD-SCLC, existing data concerning the impact of start of radiation on OS remain inconclusive. The results of Wang et al 21 con ne superiority in OS and response of patients with complete or partial remission after two or three cycles of initial chemotherapy. Further studies have shown superiority of an early start of thoracic radiation over a late or very late start.…”

Section: Discussionmentioning

confidence: 93%

Factors associated with overall survival, progression-free survival and toxicity in patients with small cell lung cancer and thoracic irradiation in a clinical real-world setting

Kassik

Vordermark

Medenwald

2022

Preprint

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BackgroundSmall-cell lung cancer (SCLC) is a malignant tumor known for its poor prognosis. In addition to chemotherapy and immunotherapy irradiation plays a big role especially in inoperability. This study evaluated prognostic factors in patients with small-cell lung cancer (SCLC), receiving chemotherapy and thoracic irradiation, that may affect overall survival (OS), progression-free survival (PFS) and toxicity.MethodsPatients with limited disease (LD) SCLC (n = 57) and extensive disease (ED) SCLC (n = 69) who received thoracic radiotherapy were analyzed retrospectively. The prognostic factors sex, age, Karnofsky performance status (KPS), tumor-, nodal-stage and timepoint of start of irradiation in relation to the first cycle of chemotherapy were evaluated. Start of irradiation was stratified as early (≤ 2 cycles of chemotherapy), late (3 or 4 cycles) and very late (≥ 5 cycles). Results were analyzed by Cox univariate and multivariate as well as logistic regression analysis.ResultsThe median OS of LD-SCLC patients was 23.7 months in early, and 22.0 months in late start of irradiation. In very late start, median OS was not reached. PFS was 11.8, 15.2 and 47.9 months, respectively. In patients with ED-SCLC OS was 4.3 months in early, 13.0 months in late and 12.2 months in very late start of irradiation. PFS was 6.7, 13.0 and 12.2 months, respectively. Prognosis of patients with LD- or ED-SCLC receiving late or very late start of irradiation was significantly prolonged in OS and PFS compared to an early start (p < 0.05). KPS ≥ 80 shows a significant increase of OS and PFS in ED-SCLC. Female sex and smaller mean lung dose were associated with lower risk of toxicity.ConclusionLate or very late start of irradiation is a prognosis-enhancing factor in LD-SCLC and ED-SCLC for OS and PFS. KPS ≥ 80 increases prognosis of OS and PFS in ED-SCLC as well. Toxicity is less common in female sex and patients with low mean lung dose in LD-SCLC.

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Does the response to induction chemotherapy impact the timing of thoracic radiotherapy for limited‐stage small‐cell lung cancer?

Cited by 6 publications

References 20 publications

Timing of thoracic radiotherapy in the treatment of extensive-stage small-cell lung cancer: important or not?

Timing of thoracic radiotherapy in the treatment of extensive-stage small-cell lung cancer: important or not?

Progression-Free Survival and Time to Progression as Potential Surrogate Endpoints for Overall Survival in Chemoradiotherapy Trials in Limited-Stage Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Factors associated with overall survival, progression-free survival and toxicity in patients with small cell lung cancer and thoracic irradiation in a clinical real-world setting

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