Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer – Evidence from a phase II trial

Colaco, Rovel; Sheikh, Hamid Y; Lorigan, Paul; Blackhall, Fiona; Hulse, Paul; Califano, Raffaele; Ashcroft, Linda; Taylor, Paul D.; Thatcher, Nick; Faivre-Finn, Corinne

doi:10.1016/j.lungcan.2011.09.015

Cited by 30 publications

(13 citation statements)

References 23 publications

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“…6,7 We conducted a prospective randomized trial that was designed to compare irradiation to the primary tumor volume before or after induction chemotherapy versus applied, involved-field radiotherapy (IFRT) to the hilar, mediastinal, and supraclavicular lymph node regions. 8 The interim analysis of this study, 8 together with other evidence from nonrandomized studies, 9,10 supported the Cancer February 15, 2020 use of IFRT, and the gross tumor volume (GTV) could include only the postinduction chemotherapy volume. 11 However, to date, no phase 3 study has been published.…”

Section: Introductionmentioning

confidence: 66%

Final report of a prospective randomized study on thoracic radiotherapy target volume for limited‐stage small cell lung cancer with radiation dosimetric analyses

Bao

et al. 2019

Cancer

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BACKGROUND:The thoracic radiotherapy (TRT) target volume for limited-stage small-cell lung cancer (SCLC) has been controversial for decades. In this report, the final results of a prospective randomized trial on the TRT target volume before and after induction chemotherapy are presented. METHODS: After 2 cycles of etoposide and cisplatin, patients arm were randomized to receive TRT to the postchemotherapy or prechemotherapy tumor volume in a study arm and a control arm. Involved-field radiotherapy was received in both arms. TRT consisted of 1.5 grays (Gy) twice daily in 30 fractions to up to a total dose of 45 Gy. Lymph node regions were contoured, and intentional and incidental radiation doses were recorded. RESULTS: The study was halted early because of slow accrual. Between 2002 and 2017, 159 and 150 patients were randomized to the study arm or the control arm, respectively; and 21.4% and 19.1% of patients, respectively, were staged using positron emission tomography/computed tomography (P = .31). With a median follow-up of 54.1 months (range, 19.9-165.0 months) in survivors, the 3-year local/regional progression-free probability was 58.2% and 65.5% in the study and control arms, respectively (P = .44), and the absolute difference was −7.3% (95% CI, −18.2%, 3.7%). In the study and control arms, the median overall survival was 21.9 months and 26.6 months, respectively, and the 5-year overall survival rate was 22.8% and 28.1%, respectively (P = .26). Grade 3 esophagitis was observed in 5.9% of patients in the study arm versus 15.5% of those in the control arm (P = .01). The isolated out-of-field failure rate was 2.6% in the study arm versus 4.1% in the control arm (P = .46), and all such failures were located in the supraclavicular fossa or contralateral hilum. The regions 7, 3P, 4L, 6, 4R, 5, and 2L received incidental radiation doses >30 Gy. CONCLUSIONS: TRT could be limited to the postchemotherapy tumor volume, and involved-field radiotherapy could be routinely applied for limited-stage SCLC. Cancer 2020;126:840-849.

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Section: Introductionmentioning

confidence: 66%

Final report of a prospective randomized study on thoracic radiotherapy target volume for limited‐stage small cell lung cancer with radiation dosimetric analyses

Bao

et al. 2019

Cancer

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“…Several reasons can be given for the observations. (1) The advanced technique of intensity-modulated radiation therapy was used in this study, which has the potential of sparing surrounding structures to prevent toxicity (23,24); (2) dose limitations to normal tissue were restricted more stringently, with the concern that increased morbidity in "late-responding" normal tissues might be seen with hypofractionation; (3) elective nodal irradiation was not used in this study, which was also considered to contribute to fewer toxicities (25,26); (4) all patients in this study received 1 or 2 cycles of induction chemotherapy, and a 92% response rate was achieved. The shrinkage of tumor volume due to induction chemotherapy could lead to smaller radiation fields and less radiation dose to the surrounding normal tissue, potentially reducing the incidence rate of acute toxicities (27,28); and (5) the chemotherapy regimen used in this study was modified to a relatively lower chemotherapy dose intensity because of concerns regarding the physical constitution and patient compliance in the Asian population (25).…”

Section: Discussionmentioning

confidence: 99%

Phase 2 Study of Accelerated Hypofractionated Thoracic Radiation Therapy and Concurrent Chemotherapy in Patients With Limited-Stage Small-Cell Lung Cancer

Xia

Hong

Cai

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…However, Colaco et al 31 also evaluated the omission of eni based on ct imaging in a subset of 31 patients enrolled on the convert trial. That report demonstrated no infs and lower rates of acute grade 3 esophagitis and pneumonitis compared with historical data [25][26][27] .…”

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confidence: 99%

Management of Small-Cell Lung Cancer with Radiotherapy—A Pan-Canadian Survey of Radiation Oncologists

et al. 2016

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Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer – Evidence from a phase II trial

Cited by 30 publications

References 23 publications

Final report of a prospective randomized study on thoracic radiotherapy target volume for limited‐stage small cell lung cancer with radiation dosimetric analyses

Final report of a prospective randomized study on thoracic radiotherapy target volume for limited‐stage small cell lung cancer with radiation dosimetric analyses

Phase 2 Study of Accelerated Hypofractionated Thoracic Radiation Therapy and Concurrent Chemotherapy in Patients With Limited-Stage Small-Cell Lung Cancer

Management of Small-Cell Lung Cancer with Radiotherapy—A Pan-Canadian Survey of Radiation Oncologists

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