Sequential Hypofractionated versus Concurrent Twice-Daily Radiotherapy for Limited-Stage Small-Cell Lung Cancer: A Propensity Score-Matched Analysis

Abstract

Background: As there are no randomized trials comparing twice-daily with sequential hypofractionated (sequential hypo) radiotherapy regimens for limited-stage small-cell lung cancer (LS-SCLC). This study aimed to compare these two regimens for LS-SCLC by propensity score-matched analysis (PSM). Methods: We retrospectively analyzed 108 LS-SCLC patients between January 2015 and July 2019. All patients received concurrent twice-daily or sequential hypo radiotherapy. The survival, failure patterns, and toxicities were evaluated before and after PSM. Results: Before PSM, multivariate analysis showed that patients treated with sequential hypo had a significantly better overall survival (OS) and distant metastasis-free survival (DMFS) (HR = 0.353, p = 0.009; HR = 0.483, p = 0.039, respectively). Total radiotherapy time ≥ 24 days and stage III (HR = 2.454, p = 0.004; HR = 2.310, p = 0.004, respectively) were poor prognostic indicators for OS. Patients with a total radiotherapy time ≥ 24 days and N2–3 were more likely to recur than others (HR = 1.774, p = 0.048; HR = 2.369, p = 0.047, respectively). N2–3 (HR = 3.032, p = 0.011) was a poor prognostic indicator for DMFS. After PSM, being aged ≥65 years was associated with poorer OS, relapse-free survival (RFS) and DMFS (p < 0.05). A total radiotherapy time of ≥24 days was a poor prognostic indicator for OS and RFS (HR = 2.671, p = 0.046; HR = 2.370, p = 0.054, respectively). Although there was no significant difference, the patients in the sequential hypo group had a trend towards a better OS. The failure pattern between the two groups showed no difference. More patients had grade 1–2 esophagitis in the twice-daily group (p = 0.001). Conclusions: After propensity matching, no difference was shown in survival and failure. The sequential hypo schedule was associated with comparable survival and less toxicity and may be used as an alternative to concurrent twice-daily regimens.

The Dose/Fractionation Debate in Limited-Stage Small Cell Lung Cancer

“…A total of 547 patients were enrolled and randomly assigned to either the twice-daily group (274 patients) or once-daily group (273 patients). With a median followup of 45 months, the results showed a two-year overall survival rate of 56% (95% CI [50][51][52][53][54][55][56][57][58][59][60][61][62] in the twice-daily group and 51% (95% CI [45][46][47][48][49][50][51][52][53][54][55][56][57] in the once-daily group (hazard ratio for death in the once-daily group, 1.18 [95% CI 0.95-1.45]; p = 0.14). Among patients assessed for radiation toxicity, there was no difference in grade 3 esophagitis and radiation pneumonitis between the two groups.…”

Segmentation of patients with small cell lung cancer into responders and non-responders using the optimal cross-validation technique

“…Small Cell Lung Cancer (SCLC) represents of all lung cancers and is known for its highly invasive capacity and early metastatic behavior [ 1 ]. Treatments for SCLC have changed very little in the past 20 years compared to other types of lung cancer [ 2 ].…”