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Radiation Oncology

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Open Access 01-12-2014 | Study protocol

Feasibility and efficacy of simultaneous integrated boost intensity-modulated radiation therapy in patients with limited-disease small cell lung cancer

Authors: Dan Han, Qin Qin, Shaoyu Hao, Wei Huang, Yumei Wei, Zicheng Zhang, Zhongtang Wang, Baosheng Li

Published in: Radiation Oncology | Issue 1/2014

Abstract

Purpose

To evaluate the feasibility and efficacy of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) in patients with limited-disease small-cell lung cancer (LD-SCLC).

Methods

Patients with LD-SCLC were treated with SIB-IMRT within 1 week after completion of 2 cycles of induction chemotherapy. Then 2-4 cycles of adjuvant chemotherapy were administered within 1 week after SIB-IMRT. Irradiation was given accelerated hyper-fractionated with the prescribed dose 57Gy at 1.9Gy twice daily to the gross tumor volume (GTV) , 51Gy at 1.7Gy twice daily to the clinical tumor volume (CTV) and 45Gy at 1.5Gy twice daily to the planning target volume (PTV). The chemotherapy regimen consisted of platinum plus etoposide. Prophylactic cranial radiation (25Gy in 10 fractions) was administered to patients who got complete response (CR) or near complete response (nCR). The primary endpoint of this study was the frequency of grade 3 or higher acute non-hematologic treatment-related toxicities. Secondary end points included objective response, overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS).

Results

A cohort of 35 patients were enrolled in the study, the biological equivalent dose (BED) of the GTV in the SIB-IMRT was 59.16Gy. Grade 1, 2, and 3 esophagitis were observed in 11 (31%), 12 (34%), and 6 (17%) patients, respectively; Grade 1 and 2 pneumonitis were observed in 8 (23%) and 4 (11%) patients, respectively. The median OS and PFS of the whole group were 37.7 months and 29.3 months, respectively. The 1- and 2-year OS was 94.1% and 68.5%, respectively. The 1- and 2-year PFS was 76.8% and 40.7%, respectively. The 1- and 2-year LRFS was 87.7% and 73.8%, respectively.

Conclusions

SIB-IMRT was feasible and well-tolerated in patients with LD-SCLC, and worth further evaluating in a large prospective clinical trial.

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van Meerbeeck JP, Fennell DA, De Ruysscher DK: Small-cell lung cancer. Lancet 2011, 378: 1741-1755. 10.1016/S0140-6736(11)60165-7CrossRefPubMed

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ: Cancer statistics 2008. CA Cancer J Clin 2008, 58: 71-96. 10.3322/CA.2007.0010CrossRefPubMed

Pignon JP, Arriagada R, Ihde DC, Johnson DH, Perry MC, Souhami RL, Brodin O, Joss RA, Kies MS, Lebeau B: A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 1992, 327: 1618-1624. 10.1056/NEJM199212033272302CrossRefPubMed

Warde P, Payne D: Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 1992, 10: 890-895.PubMed

Bogart J, Masters G, Komaki R, Heymach J: Phase III Comparison of Thoracic Radiotherapy Regimens in Patients With Limited Small Cell Lung Cancer Also Receiving Cisplatin and Etoposide. Current Controlled Trials. 2008.

Yee D, Hanson J, Butts C, Reiman A, Joy A, Smylie M, Fenton D, Chu Q, Roa W: Phase I dose escalation trial of hypofractionated limited-field external beam thoracic radiotherapy for limited-stage small cell carcinoma of the lung. Radiother Oncol 2010, 96: 78-83. 10.1016/j.radonc.2010.05.013CrossRefPubMed

Komaki R, Paulus R, Ettinger DS, Videtic GM, Bradley JD, Glisson BS, Langer CJ, Sause WT, Curran WJ Jr, Choy H: Phase II study of accelerated high-dose radiotherapy with concurrent chemotherapy for patients with limited small-cell lung cancer: radiation therapy oncology group protocol 0239. Int J Radiat Oncol Biol Phys 2012, 83: e531-e536. 10.1016/j.ijrobp.2012.01.075PubMedCentralCrossRefPubMed

Franceschini D, Paiar F, Meattini I, Agresti B, Pasquetti EM, Greto D, Bonomo P, Marrazzo L, Casati M, Livi L, Biti G: Simultaneous integrated boost–intensity‐modulated radiotherapy in head and neck cancer. Laryngoscope 2013, 123: E97-E103. 10.1002/lary.24257CrossRefPubMed

Wu B, McNutt T, Zahurak M, Simari P, Pang D, Taylor R, Sanguineti G: Fully automated simultaneous integrated boosted–intensity modulated radiation therapy treatment planning is feasible for head-and-neck cancer: a prospective clinical study. Int J Radiat Oncol Biol Phys 2012, 84: e647-e653. 10.1016/j.ijrobp.2012.06.047CrossRefPubMed

10.

Deenen MJ, Dewit L, Boot H, Beijnen JH, Schellens JH, Cats A: Simultaneous integrated boost–intensity modulated radiation therapy with concomitant capecitabine and mitomycin C for locally advanced anal carcinoma: a phase 1 study. Int J Radiat Oncol Biol Phys 2013, 85: e201-e207. 10.1016/j.ijrobp.2012.12.008CrossRefPubMed

11.

Fogliata A, Bolsi A, Cozzi L, Bernier J: Comparative dosimetric evaluation of the simultaneous integrated boost with photon intensity modulation in head and neck cancer patients. Radiother Oncol 2003, 69: 267-275. 10.1016/j.radonc.2003.10.003CrossRefPubMed

12.

Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A, Bentzen SM, Nam J, Deasy JO: Use of normal tissue complication probability models. Int J Radiat Oncol Biol Phys 2010,76(Suppl 3):S10-S19. 10.1016/j.ijrobp.2009.07.1754PubMedCentralCrossRefPubMed

13.

Gagliardi G, Constine LS, Moiseenko V, Correa C, Pierce LJ, Allen AM, Marks LB: Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 2010, 76: S77-S85. 10.1016/j.ijrobp.2009.04.093CrossRefPubMed

14.

Liu HH, Wang X, Dong L, Wu Q, Liao Z, Stevens CW, Guerrero TM, Komaki R, Cox JD, Mohan R: Feasibility of sparing lung and other thoracic structures with intensity- modulated radiotherapy for non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2004, 58: 1268-1279. 10.1016/j.ijrobp.2003.09.085CrossRefPubMed

15.

Turrisi AT 3rd, Kim K, Blum R, Sause WT, Livingston RB, Komaki R, Wagner H, Aisner S, Johnson DH: Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 1999, 340: 265-271. 10.1056/NEJM199901283400403CrossRefPubMed

16.

Schild SE, Bonner JA, Hillman S, Kozelsky TF, Vigliotti AP, Marks RS, Graham DL, Soori GS, Kugler JW, Tenglin RC, Wender DB, Adjei A: Results of a phase II study of high-dose thoracic radiation therapy with concurrent cisplatin and etoposide in limited stage small cell lung cancer (NCCTG 95-20-53). J Clin Oncol 2007, 25: 3124-3129. 10.1200/JCO.2006.09.9606CrossRefPubMed

17.

Xia B, Chen GY, Cai XW, Zhao JD, Yang HJ, Fan M, Zhao KL, Fu XL: The effect of bioequivalent radiation dose on survival of patients with limited-stage small-cell lung cancer. Radiat Oncol 2011, 6: 50. 10.1186/1748-717X-6-50PubMedCentralCrossRefPubMed

18.

Choi NC, Herndon JE II, Rosenman J, Carey RW, Chung CT, Bernard S, Leone L, Seagren S, Green M: Phase I study to determine the maximum-tolerated dose of radiation in standard daily and hyperfractionated-accelerated twice-daily radiation schedules with concurrent chemotherapy for limited-stage small-cell lung cancer. J Clin Oncol 1998, 16: 3528-3536.PubMed

19.

Minoru T, Masahiro F, Masaaki K, Takahiko S, Akira Y, Soichiro Y, Yutaka N, Koshiro W, Kazumasa N, Tomohide T, Haruhiko F, Nagahiro S: Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 2002, 20: 3054-3060. 10.1200/JCO.2002.12.071CrossRef

20.

Murray N, Coy P, Pater JL, Hodson I, Arnold A, Zee BC, Payne D, Kostashuk EC, Evans WK, Dixon P: Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1993, 11: 336-344.PubMed

21.

De Ruysscher D, Pijls-Johannesma M, Bentzen SM, Minken A, Wanders R, Lutgens L, Hochstenbag M, Boersma L, Wouters B, Lammering G, Vansteenkiste J, Lambin P: Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 2006, 24: 1057-1063. 10.1200/JCO.2005.02.9793CrossRefPubMed

22.

Fowler JF: Biological factors influencing optimum fractionation in radiation therapy. Acta Oncol 2001, 40: 712-717. 10.1080/02841860152619124CrossRefPubMed

23.

Fowler JF: The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 1989, 62: 679-694. 10.1259/0007-1285-62-740-679CrossRefPubMed

24.

Aupérin A, Arriagada R, Pignon JP, Le Péchoux C, Gregor A, Stephens RJ, Kristjansen PE, Johnson BE, Ueoka H, Wagner H, Aisner J: Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 1999, 341: 476-484. 10.1056/NEJM199908123410703CrossRefPubMed

25.

Tai P, Assouline A, Joseph K, Stitt L, Yu E: Prophylactic cranial irradiation for patients with limited-stage small-cell lung cancer with response to chemoradiation. Clin Lung Cancer 2013, 14: 40-44. 10.1016/j.cllc.2012.04.005CrossRefPubMed

Title: Feasibility and efficacy of simultaneous integrated boost intensity-modulated radiation therapy in patients with limited-disease small cell lung cancer
Authors: Dan Han
Qin Qin
Shaoyu Hao
Wei Huang
Yumei Wei
Zicheng Zhang
Zhongtang Wang
Baosheng Li
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-014-0280-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility and efficacy of simultaneous integrated boost intensity-modulated radiation therapy in patients with limited-disease small cell lung cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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