Clinical Study

Sequential chemotherapy followed by radical thoracic radiotherapy (50 Gy in 25 fractions) in limited stage small cell lung cancer

9 Mar 2020
Muhammad Shahid Iqbal, Joseph Carlow, Fiona McDonald, Philip Atherton, Helen Turnbull, Sandeep Singhal, Timothy Simmons, Paula Mulvenna, Josef Kovarik, Rhona McMenemin, Jill Gardiner, Alastair Greystoke

Introduction: For limited stage small cell lung cancer (LS-SCLC) where concurrent chemoradiotherapy is inappropriate due to tumour bulk, co-morbidities or performance status, sequential treatment using chemotherapy followed by radiotherapy is the standard of care. The outcomes are not well established; we assessed in a single institution, the survival of these patients, prognostic factors and compared to the limited existing literature.

Materials and Method: Retrospective data was collected on all 59 patients diagnosed with LS-SCLC from 2011 to 2016 who received chemotherapy consisting of Carboplatin or Cisplatin Etoposide followed by thoracic radiotherapy (50 Gy in 25 fractions) /- prophylactic cranial irradiation (PCI).

Results: Median age at diagnosis was 66 years (range 46–90). Patients received a median of four cycles of chemotherapy (range: 1–6) and all the patients completed a full course of radiotherapy with only one patient experiencing grade >2 radiation induced toxicity. With a median follow up of 20.6 months, 45 patients had died with a median survival of 20.6 months. 2-year overall survival (OS) rates were 42%. Age using a cut-off of 65 was prognostic (median OS 25.6 months ≤65 years versus 14.1 months >65 years, p = 0.013) but gender, stage and receipt of PCI were not.

Conclusions: Most of the literature reporting outcome from sequential treatment in LS-SCLC is old and used a variety of radiotherapy regimens. Our data shows inferior outcomes to the gold standard concurrent chemoradiotherapy but support its usage in less fit patients with reasonable outcome observed.

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