Phase II Trial of Up-Front Accelerated Thoracic Radiotherapy Combined With Chemotherapy and Optional Up-Front Prophylactic Cranial Irradiation in Limited Small-Cell Lung Cancer

Abstract

This trial demonstrates that up-front accelerated TR associated with CT is feasible, has acceptable toxicity, and shows considerable long-term survival potential.

Is there a place for low-dose chest and prophylactic brain irradiation in limited-disease small cell lung cancer

“…In an observation of the national cancer data base of the US of LD-SCLC treated with chemo-radiation therapy from 1995, the 5-year survival rate was 13.3% [18]. Two other studies from our center with chemo-radiotherapy in LD-SCLC were previously published [12,13]. In both studies, RT started up-front.…”

“…Site of first progression was loco-regional in 9 (only 1 patient with out-field failure) and distant in 7 patients with two of them in the CNS. The 5-year local failure rate, defined as recurrence inside the irradiated volume, was 40% after a median of 12 months (range, [6][7][8][9][10][11][12][13][14][15][16][17]. Seven of them received a salvage RT with a median dose of 37.5 Gy (range, 20-45); concomitant CHT was applied in 5 of these patients.…”

“…In two previous published studies, our hospital evaluated the effectiveness of an up-front TR followed by a cisplatinbased CHT [12,13]. In one of these series, a low-dose TR showed considerable response and survival rates.…”

Prophylactic Cranial Irradiation in Limited-Disease Small-Cell Lung Cancer – Why, When, How Much?

“…All of the above-described trials involved patients who received PCI after completion of induction chemotherapy or chemoradiotherapy. There have been two studies giving PCI before chemotherapy [10,11]. However, the optimal application time of brain irradiation in relation to administration of chemotherapy was not systematically evaluated.…”

Management of the Brain in Small Cell Lung Cancer: Are Patients Paying a Lot Now Instead of a Little Later?

“…Whether changing how treatment is given-the question probed in the current CONVERT analysis-has an impact on the development of BM is less clear. Small prospective trials suggest that early administration of PCI may reduce BM, either from a direct effect on subclinical BMs or by disrupting the blood-brain barrier and allowing better chemotherapy penetration, 11 but such a strategy has not been widely studied. On the other hand, the timing of TRT has been extensively evaluated.…”