Stereotactic body radiotherapy with concurrent chemotherapy extends survival of patients with limited stage small cell lung cancer: a single-center prospective phase II study

Abstract

We carried out a prospective phase II study of patients with limited stage small cell lung cancer (LS-SCLC) assigned to receive stereotactic body radiotherapy (SBRT) concurrently with cisplatin-based chemotherapeutic regimen with OS and PFS as the primary study endpoints. Patients with pathologically proven LS-SCLC received 4-6 cycles of cisplatin 75 mg/(m(2)/day) given intravenously on day 1 and etoposide 80 mg/(m(2)/day) given intravenously on days 1-5, both at 3 weekly intervals. SBRT at a dose of 4,000-4,500 cGy in ten fractions was given concurrently with chemotherapy starting on day 1. The Kaplan-Meier curve and life tables were used to describe survival data. Adverse events were evaluated according to the common terminology criteria for adverse events version of the radiation therapy oncology group (RTOG). Twenty-nine patients were included and followed up for a median duration of 19 (range 10-85) months. The median OS was 27 (95% CI 20.2-33.8) months. The median PFS was 12 (95% CI 4.2-19.8) months. No grade 4 adverse events were observed. Grade 3 adverse events occurred in only 5 (13.8%, 5/29) patients. Neutropenia of any grade was observed in 6 (15%, 6/29) patients, with grade 3 neutropenia only seen in one (3.4%, 1/29) patient. The combination of chemotherapy and early concurrent SBRT could be a safe and effective treatment for LS-SCLC patients. Our study confirmed that SBRT with concurrent chemotherapy is another new treatment option for LS-SCLC patients.

The Role of Radiotherapy in Small Cell Lung Cancer: a Revisit

“…The utility of SBRT in the setting of SCLC is clearly an area for further investigation and development. In that regard, a recent prospective phase II study from China claimed improved survival through the use of SBRT with concurrent chemotherapy for LS-SCLC patients [15]. Patients in this study had more conventional LS-SCLC (i.e., node-positive).…”

Radiation Therapy for Small-Cell Lung Cancer: ASCO Guideline Endorsement of an ASTRO Guideline

“…There is very limited data on the safety of delivering SBRT and chemotherapy concurrently, and it is not currently recommended. 14…”

The utilization of immunotherapy with radiation therapy in lung cancer: a narrative review

“…In early stage lung cancer, newer radiation technologies have allowed delivery of high dose, highly conformal hypofractionated regimens over 1-5 fractions to patients who are medically unfit for surgery (9,10). Known as SBRT or stereotactic ablative body radiation (SABR), these ablative regimens have become standard of care for early stage NSCLC and are also being utilized increasingly for patients with early stage SCLC (11,12). These regimens have been extensively studied internationally through prospective phase 2 and 3 studies with results showing local control rates of approximately 90-95%, similar to lobectomy (13)(14)(15).…”