NEW YORK (Reuters Health) May 31 - Thoracic radiation therapy extends overall survival in patients with extensive-stage small cell lung cancer, or ED-SCLC, researchers from China report.
"We hope the results of our study can give a message to physicians that for the patients with 'poor prognosis' (ED-SCLC), more optimal active treatment could give optimal palliative results with minimal treatment-related toxicity and limited cost," Dr. Luhua Wang from the Chinese Academy of Medical Science and Peking Union Medical College in Beijing told Reuters Health by email.
Dr. Wang and colleagues reviewed the effect of thoracic radiation therapy in 60 patients with SCLC who had distant metastasis at presentation and compared them to 59 similar patients who had chemotherapy alone.
The overall complete response rate was significantly higher in patients who had chemo plus radiation: 86.7% vs 62.7% (P=0.003). Also, median overall survival was nearly doubled in the radiation group: 17 vs 9.3 months, according to a report published online May 11th in Cancer.
At two years, overall survival and progression-free survival were significantly higher in the radiation group (35% and 12.6%, respectively) than in the chemotherapy-only group (17% and 7.2%, respectively). Both outcomes were again better in the radiation group at five years.
There was a trend toward better overall survival in the radiation group among subgroups with metastasis to one organ and/or with Karnofsky performance status (KPS) scores of 80 or above and in patients without brain metastases.
In multivariate analysis, thoracic radiotherapy and receipt of at least four cycles of chemotherapy were the only two independent predictors of better overall survival.
Local relapse rates decreased significantly with receipt of thoracic radiation therapy, but distant control rates remained disappointing.
Except for leukopenia, which was more common in the radiation group, toxicities didn't differ significantly between the treatment groups.
Dr. Wang said the results suggest that if consolidation radiotherapy is given before thoracic lesions cause clinical symptoms, it could considered as a prophylactic palliative measure and could prolong progression-free survival and overall survival.
"So, in my point of view, at the present time, thoracic radiation therapy can be recommended for ED-SCLC patients," Dr. Wang said.
But, Dr. Wang cautions, "There are still some critical questions that need to be answered in future studies to assess the value of thoracic radiation therapy for this kind of patient," such as timing, total irradiation doses, fraction dose, and the timing of prophylactic cranial irradiation.
"We hope the results of our study can give a message to physicians that for the patients with 'poor prognosis' (ED-SCLC), more optimal active treatment could give optimal palliative results with minimal treatment-related toxicity and limited cost," Dr. Luhua Wang from the Chinese Academy of Medical Science and Peking Union Medical College in Beijing told Reuters Health by email.
Dr. Wang and colleagues reviewed the effect of thoracic radiation therapy in 60 patients with SCLC who had distant metastasis at presentation and compared them to 59 similar patients who had chemotherapy alone.
The overall complete response rate was significantly higher in patients who had chemo plus radiation: 86.7% vs 62.7% (P=0.003). Also, median overall survival was nearly doubled in the radiation group: 17 vs 9.3 months, according to a report published online May 11th in Cancer.
At two years, overall survival and progression-free survival were significantly higher in the radiation group (35% and 12.6%, respectively) than in the chemotherapy-only group (17% and 7.2%, respectively). Both outcomes were again better in the radiation group at five years.
There was a trend toward better overall survival in the radiation group among subgroups with metastasis to one organ and/or with Karnofsky performance status (KPS) scores of 80 or above and in patients without brain metastases.
In multivariate analysis, thoracic radiotherapy and receipt of at least four cycles of chemotherapy were the only two independent predictors of better overall survival.
Local relapse rates decreased significantly with receipt of thoracic radiation therapy, but distant control rates remained disappointing.
Except for leukopenia, which was more common in the radiation group, toxicities didn't differ significantly between the treatment groups.
Dr. Wang said the results suggest that if consolidation radiotherapy is given before thoracic lesions cause clinical symptoms, it could considered as a prophylactic palliative measure and could prolong progression-free survival and overall survival.
"So, in my point of view, at the present time, thoracic radiation therapy can be recommended for ED-SCLC patients," Dr. Wang said.
But, Dr. Wang cautions, "There are still some critical questions that need to be answered in future studies to assess the value of thoracic radiation therapy for this kind of patient," such as timing, total irradiation doses, fraction dose, and the timing of prophylactic cranial irradiation.
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