TY - JOUR
T1 - International multicenter randomized study on thoracic radiation therapy (RT) in extensive stage small cell lung cancer (ES-SCLC)
T2 - patterns of disease recurrence (2014 ASTRO oral scientific sessionclinical trials)
AU - Slotman, B.J.
AU - Faivre-Finn, C.
AU - Tinteren, H. van
AU - Praag, J.
AU - Knegjens, J.
AU - Sharouni, S. el
AU - Hatton, M.
AU - Keijser, A.
AU - Senan, S.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Purpose/Objective(s)
Prophylactic cranial irradiation (PCI) reduces the risk of brain metastases, and it improves survival in ES-SCLC patients who respond to chemotherapy. Since most patients have residual intrathoracic disease after chemotherapy, we performed a randomized trial evaluating the role of TRT in addition to PCI. In this analysis, we report on the recurrence patterns. Analysis of survival and toxicity having been submitted to ASCO 2014.
Materials/Methods
Patients with confirmed ES-SCLC who responded to 4-6 cycles of platinum-etoposide were randomized to TRT (30 Gy/10 fx) or no TRT. All received PCI. The primary study endpoint was overall survival. Analysis was based on intent to treat.
Results
Four hundred ninety-eight patients were enrolled (249 per arm); 3 patients withdrew informed consent leaving 247 (TRT) and 248 patients (control arm). Median follow-up was 24 months. The rate of intrathoracic recurrence as first site of relapse was 41.7% in TRT arm vs. 77.8%, in the control arm (p < 0.001); this was 20.6% and 48.0 % respectively (p < 0.001) for intrathoracic recurrence as the only site of first relapse. Progression elsewhere, with or without progression in thorax and/or brain as first site of relapse, occurred in 59.5% in the TRT arm, compared to 38.3% in the control arm (P < 0.001) with no significant difference in the risk of brain metastases as first site of relapse (8.5% vs. 4.0%; p = 0.06). Progression-free survival was longer in the TRT-arm (HR = 0.73, CI = 0.61-0.87; p = 0.001). There was no significant difference in overall survival in the first year. At 2 years, overall survival was 13% (CI = 9-19) in the TRT arm and 3% (CI = 2-8%) in the control arm (P = 0.004).
Conclusions
TRT improves progression free survival, results in fewer intrathoracic recurrences and improves 2 years overall survival. TRT should be offered to all ES-SCLC patients with a response to initial chemotherapy. The higher rate of progression outside thorax and brain in the TRT arm warrants studies on consolidative radiation therapy to other sites of distant disease.
AB - Purpose/Objective(s)
Prophylactic cranial irradiation (PCI) reduces the risk of brain metastases, and it improves survival in ES-SCLC patients who respond to chemotherapy. Since most patients have residual intrathoracic disease after chemotherapy, we performed a randomized trial evaluating the role of TRT in addition to PCI. In this analysis, we report on the recurrence patterns. Analysis of survival and toxicity having been submitted to ASCO 2014.
Materials/Methods
Patients with confirmed ES-SCLC who responded to 4-6 cycles of platinum-etoposide were randomized to TRT (30 Gy/10 fx) or no TRT. All received PCI. The primary study endpoint was overall survival. Analysis was based on intent to treat.
Results
Four hundred ninety-eight patients were enrolled (249 per arm); 3 patients withdrew informed consent leaving 247 (TRT) and 248 patients (control arm). Median follow-up was 24 months. The rate of intrathoracic recurrence as first site of relapse was 41.7% in TRT arm vs. 77.8%, in the control arm (p < 0.001); this was 20.6% and 48.0 % respectively (p < 0.001) for intrathoracic recurrence as the only site of first relapse. Progression elsewhere, with or without progression in thorax and/or brain as first site of relapse, occurred in 59.5% in the TRT arm, compared to 38.3% in the control arm (P < 0.001) with no significant difference in the risk of brain metastases as first site of relapse (8.5% vs. 4.0%; p = 0.06). Progression-free survival was longer in the TRT-arm (HR = 0.73, CI = 0.61-0.87; p = 0.001). There was no significant difference in overall survival in the first year. At 2 years, overall survival was 13% (CI = 9-19) in the TRT arm and 3% (CI = 2-8%) in the control arm (P = 0.004).
Conclusions
TRT improves progression free survival, results in fewer intrathoracic recurrences and improves 2 years overall survival. TRT should be offered to all ES-SCLC patients with a response to initial chemotherapy. The higher rate of progression outside thorax and brain in the TRT arm warrants studies on consolidative radiation therapy to other sites of distant disease.
U2 - 10.1016/j.ijrobp.2014.06.023
DO - 10.1016/j.ijrobp.2014.06.023
M3 - Conference article
SN - 1879-355X
VL - 90
SP - S3-S4
JO - International Journal of Radiation: Oncology - Biology - Physics
JF - International Journal of Radiation: Oncology - Biology - Physics
IS - 1
ER -
