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70 Gy Thoracic Radiotherapy (TRT) is Feasible Concurrent with Chemotherapy for Limited Stage Small Cell Lung Cancer (L-SCLC): Preliminary Analysis of a CALGB Phase II Trial

Reviewer: William Levin, MD
OncoLink
Last Modified: October 9, 2002

Presenter: J.A. Bogart
Presenter's Affiliation: Upstate Medical University, Syracuse, NY, USA
Type of Session: Scientific

Background

• This study was designed to further investigate the optimal treatment regimen for L-SCLC.
• A previous randomized intergroup trial showed a survival benefit for twice-daily TRT (total 45 Gy) with chemotherapy, versus chemotherapy and once daily radiation therapy (total 45 Gy).
• The current study was designed to prospectively study the feasibility and efficacy of 70 Gy/in once-daily fractions with concurrent chemotherapy.

Materials and Methods

• 63 patients were enrolled on the study. They received 70 Gy in TRT in 2 Gy per day fractions. Patients received 2 cycles of Taxol prior to TRT. They then received 3 cycles of carboplatin/etoposide concurrently with TRT.
• Prophylactic cranial irradiation (PCI) was given to those patients with a CR or good PR to therapy.
• TRT was to the post-induction chemotherapy volume.

Results

• Median follow-up is 18.4 months.
• Mean age was 60 years.
• 90% of patients proceeded to TRT following induction chemotherapy.
• One fatality occurred on treatment during the TRT phase.
• Non-hematologic grade 3/4 toxicities were seen in 10% of patients.
• Febrile neutropenia was seen in 16% of patients.
• No grade 4 pulmonary toxicity has been reported.
• 65% of patients experienced a CR or sustained PR (stable for 6 months or more).

Author's Conclusions

• 70 Gy/once daily TRT can safely be given with concurrent chemotherapy for L-SCLC.
• Longer follow-up is necessary before drawing conclusions regarding efficacy.

Clinical/Scientific Implications

• Short term analysis of this study suggests that once-daily radiation given to 70 Gy with chemotherapy may be possible, but again, follow-up is short.
• Once-daily high dose TRT treatments, if safe and effective, would need to be tested against the current standard regimen of BID irradiation in patients with excellent performance status.

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