Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer

Ruysscher, Dirk De; Pijls‐Johannesma, Madelon; Vansteenkiste, Johan; Kester, A.D.M.; Rutten, Isabelle; Lambin, Philippe

doi:10.1093/annonc/mdj094

Cited by 157 publications

(87 citation statements)

References 31 publications

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“…That finding is again supported by the Murray et al trial 19 , despite a similar rct conducted in the United Kingdom, which suggested no os benefit for early compared with late ccrt 23 . A meta-analysis by De Ruysscher et al 24 of trials evaluating the timing of ccrt showed a trend toward improved os with early ccrt, particularly if the chemotherapy was platinum-based. The convert trial also mandated early ccrt, and because many Canadian centres were involved in that trial, their involvement likely influenced our findings.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…The baseline characteristics were similar between the early and late PCI groups; therefore, this result was not confounded by other clinical factors. It is well established that early chest radiotherapy may improve the survival rate of patients with LS-SCLC (22). As a prophylactic treatment, it is unknown whether early PCI may be as effective as early chest radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Qiu

Xiao-fang

et al. 2016

Oncology Letters

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Abstract. The benefit of prophylactic cranial irradiation (PCI) in limited-stage small-cell lung cancer (LS-SCLC) was established in a meta-analysis performed in 1999. Since then, considerable progress has been made in the diagnosis, staging and treatment of LS-SCLC, including chemotherapy and radiotherapy, which led to a longer survival time in patients. Therefore, the magnitude of the benefit of PCI should be re-evaluated. Furthermore, the optimum timing of PCI for LS-SCLC treatment has not been established and more data is required to demonstrate this. In the present retrospective study, the cases of patients that were diagnosed with LS-SCLC between March 2005 and December 2010 were reviewed. The main eligibility criteria of patients were a diagnosis of LS-SCLC and the achievement of a complete response (CR) or near CR subsequent to receiving ≥3 cycles of cisplatin-based chemotherapy, with or without advanced thoracic radiotherapy. Early and late PCI groups were separated using the median time interval between the start of primary chemotherapy and the start of PCI. In total, 80 patients were excluded from the analysis, including 9 patients that developed brain metastases, 2 during primary chemotherapy and 7 during radiotherapy. The remaining 399 patients were deemed eligible. PCI was administered to 185 patients; 92 patients were in the early PCI group and 93 were in the late PCI group. PCI significantly decreased the incidence of brain metastases [P<0.001; HR, 0.24; 95% confidence interval (CI), 0.15-0.39] and improved the overall survival time of the patients (median survival time, 21.5-38.8 months; P<0.001; HR, 0.60; 95% CI, 0.45-0.79). However, no significant difference was identified between the early and late PCI groups, either in the incidence of brain metastases (P= 0.875) or the overall survival time (P= 0.361). Multivariate analysis revealed that PCI (P=0.004) and thoracic radiotherapy (P= 0.023) were the only 2 independent favorable prognostic factors of overall survival time. The present study demonstrates that PCI may be of considerable benefit to increase the survival rate and time of patients, and early PCI is as effective as late PCI. However, the present study recommends that PCI should be offered as soon as primary chemotherapy is completed, since there is a greater risk of developing brain metastases during thoracic radiotherapy.

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“…The initiation of TRT concurrent with chemotherapy, during the first two cycles, and a start to end of radiotherapy Ͻ30 days appear to improve the efficacy of chemoradiotherapy. The data from individual trials investigating the timing of TRT are contradictory, but three meta-analyses [20,21,32], based on published data, suggest that TRT should be started early, and an accelerated regimen should be considered in combination with platinum-based therapy. A meta-analysis based on individual data may provide additional information about the optimal time to initiation of TRT and a better estimate of the magnitude of benefit.…”

Section: Discussionmentioning

confidence: 99%

Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

Stinchcombe

Gore

2010

The Oncologist

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In the U.S., the prevalence of small cell lung cancer (SCLC) is declining, probably reflecting the decreasing prevalence of tobacco use. However, a significant number of patients will receive a diagnosis of SCLC, and approximately 40% of patients with SCLC will have limited-stage (LS) disease, which is potentially curable with the combination of chemotherapy and radiation therapy. The standard therapy for LS-SCLC is concurrent chemoradiotherapy, and the 5-year survival rate observed in clinical trials is approximately 25%. The standard chemotherapy remains cisplatin and etoposide, but carboplatin is frequently used in patients who cannot tolerate or have a contraindication to cisplatin. Substantial improvements in survival have been made through improvements in radiation therapy. Concurrent chemoradiotherapy is the preferred therapy for patients who are appropriate candidates. The optimal timing of concurrent chemoradiotherapy is during the first or second cycle, based on data from meta-analyses. The optimal radiation schedule and dose remain topics of debate, but 1.5 Gy twice daily to a total of 45 Gy and 1.8 -2.0 Gy daily to a total dose of 60 -70 Gy are commonly used treatments. For patients who obtain a near complete or complete response, prophylactic cranial radiation reduces the incidence of brain metastases and improves overall survival. The ongoing Radiation Therapy Oncology Group and Cancer and Leukemia Group B and the European and Canadian phase III trials will investigate different radiation treatment paradigms for patients with LS-SCLC, and completion of these trials is critical.

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Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer

Abstract: There are indications that the 5-year survival rates of patients with LS-SCLC are in favour of early chest radiotherapy, with a significant difference if the overall treatment time of chest radiation is less than 30 days.

Cited by 157 publications

References 31 publications

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

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

Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

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