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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 2/2017

01-02-2017 | Original Article

Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer

A single-centre retrospective study

Authors: Assoc. Prof. Beata Sas-Korczyńska, MD, PhD, Elżbieta Łuczyńska, Wojciech Kamzol, Andrzej Sokołowski

Published in: Strahlentherapie und Onkologie | Issue 2/2017

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Abstract

Introduction

The most effective therapy in patients with limited-stage small cell lung cancer (LS SCLC) seems to be chemotherapy (using platinum-based regimens) and thoracic radiotherapy (TRT), which is followed by prophylactic cranial irradiation.

Materials and methods

The analysed group comprised 217 patients who received combined treatment for LS SCLC, i.e. chemotherapy (according to cisplatin and etoposide schedule) and TRT (concurrent in 101 and sequential in 116 patients). The influence of chemoradiotherapy (ChT-RT) schedule on treatment results (frequency of complete response, survival rates, and incidence of treatment failure and complications) was evaluated, and the frequency and severity of pulmonary complications were analysed to identify risk factors.

Results

The 5‑year survival rates in concurrent vs. sequential ChT-RT schedules were 27.3 vs. 11.7% (overall) and 28 vs. 14.3% (disease-free). The frequencies of adverse events in relation to concurrent vs. sequential therapy were 85.1 vs. 9.5% (haematological complications) and 58.4 vs. 38.8% (pulmonary fibrosis), respectively. It was found that concurrent ChT-RT (hazard ratio, HR 2.75), a total dose equal to or more than 54 Gy (HR 2.55), the presence of haematological complications (HR 1.89) and a lung volume receiving a dose equal to or greater than 20 Gy exceeding 31% (HR 1.06) were the risk factors for pulmonary complications.

Conclusion

Pulmonary complications after ChT-RT developed in 82% of patients treated for LS SCLC. In comparison to the sequential approach, concurrent ChT-RT had a positive effect on treatment outcome. However, this is a factor that can impair treatment tolerance, which manifests in the appearance of side effects.
Literature
1.
Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 2013(63):11–30CrossRef
2.
Jett JR, Schild SE, Kesler KA, Kalemkerian GP (2013) Treatment of small cell lung cancer. Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 143:400–419CrossRef
3.
Paumier A, Le Pechoux C (2010) Radiotherapy in small-cell lung cancer: where should it go? Lung Cancer 69:133–140CrossRefPubMed
4.
Videtic GMM (2013) The role of radiation therapy in small cell lung cancer. Curr Oncol Rep 15:405–410CrossRefPubMed
5.
Planchard D, Le Pechoux C (2011) Small cell lung cancer: new recommendations and current status of biomarker assessment. Eur J Cancer 47(Suppl 3):272–283CrossRef
6.
Fruh M, De Ruysscher D, Popat S, Crinò L, Peters S, Felip E, ESMO Guidelines Working Group (2013) Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24:99–105CrossRef
7.
Goldberg SB, Willers H, Heist RS (2013) Multidisciplinary management of small cell lung cancer. Surg Oncol Clin N Am 22:329–343CrossRefPubMed
8.
9.
Kallianos A, Rapti A, Zarogoulidis P, Tsakiridis K, Mpakas A et al (2013) Therapeutic procedure in small cell lung cancer. J Thorac Dis 5(s4):420–S424
10.
Stinchombe TE, Gore EM (2010) Limited-stage small lung cancer: current chemoradiotherapy treatment paradigms. Oncologist 15:187–195CrossRef
11.
12.
Morabito A, Carillio G, Daniele G, Piccirillo MC, Montanino A et al (2014) Treatment of small cell lung cancer. Crit Rev Oncol Hematol 91:257–270CrossRefPubMed
13.
Rudin CM, Ismaila N, Hann CL, Malhotra N, Movsas B et al (2015) Treatment of small-cell lung cancer: American Society of Clinical Oncology endorsement of the American College of Chest Physicians guideline. J Clin Oncol 33:4106–4111CrossRefPubMed
14.
Perry MC (2016) Thoracic radiation therapy in limited stage small-cell lung cancer: timing is everything … isn’t it? J Clin Oncol 24:3815–3816CrossRef
15.
Slotman BJ, Senan S (2011) Radiotherapy in small-cell lung cancer: lessons learned and future directions. Int J Radiat Oncol Biol Phys 79:998–1003CrossRefPubMed
16.
Erridge SC, Murray N (2003) Thoracic radiotherapy for limited-stage small cell lung cancer: issues of timing, volumes, dose, and fractionation. Semin Oncol 30:26–37CrossRefPubMed
17.
Fried DB, Morris DE, Poole C, Rosenman JG, Halle JS et al (2004) Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer. J Clin Oncol 22:4785–4793CrossRef
18.
De Ruysscher D, Pijls-Johannesma M, Vansteenkiste J, Kester A, Rutten I, Lambin P (2006) Systematic review and meta-analysis of randomised, controlled trials of the timing of chest radiotherapy in patients with limited-stage, small-cell lung cancer. Ann Oncol 17:543–552CrossRefPubMed
19.
Spiro SG, James LE, Rudd RM, Trask CW, Tobias JS, Snee M et al (2006) Early compared with late radiotherapy in combined modality treatment for limited disease small-cell lung cancer: a London Lung Cancer Group multicenter randomized clinical trial and meta-analysis. J Clin Oncol 24:3823–3830CrossRefPubMed
20.
Manapov F, Klocking S, Niyazi M, Belka C, Hildebrandt G et al (2012) Chemoradiotehrapy duration correlates with overall survival in limited disease SCLC patients with poor initial performance status who successfully completed multimodality treatment. Strahlenther Onkol 188:29–34CrossRefPubMed
21.
Schild SE, Bonner JA, Hillman S, Kozelsky TF, Vigliotti AP et al (2007) 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 25:3124–3129CrossRefPubMed
22.
Geara FB, Komaki R, Tucker SL, Travis EL, Cox JD (1998) Factors influencing the development of lung fibrosis after chemoradiation for small cell carcinoma of the lung: evidence for inherent interindividual variation. Int J Radiat Oncol Biol Phys 41:279–286CrossRefPubMed
23.
DeRuysscher D, Van Meerbeek J, Van de Casteele K, Oberije C, Pijls M et al (2012) Radiation-induced oesophagitis in lung cancer patients. Is susceptibility for neutropenia a risk factor? Strahlenther Onkol 188:564–567CrossRef
24.
Tsujino K, Hirota S, Kotani Y, Kado T, Yoden E et al (2006) Radiation pneumonitis following concurrent accelerated hyperfractionated radiotherapy and chemotherapy for limited-stage small-cell lung cancer: dose-volume histogram analysis and comparison with conventional chemoradiation. Int J Radiat Oncol Biol Phys 64:1100–1105CrossRefPubMed
25.
Ha IB, Jeong BK, Jeong H, Choi HS, Chai GY et al (2013) Effect of early chemoradiotherapy in patients with limited stage small cell lung cancer. Radiat Oncol J 31:185–190CrossRefPubMedPubMedCentral
26.
Lu H, Fang L, Wang X, Cai J, Mao W (2014) A meta analysis of randomized controlled trials comparing early and late concurrent thoracic radiotherapy with etoposide and cisplatin/carboplatin chemotherapy for limited-disease small-cell lung cancer. Mol Clin Oncol 2:805–810PubMedPubMedCentral
27.
Sas-Korczynska B (2006) Preliminary results and toxicity of modified schedule of chemo-radiotherapy in patients with limited stage small-cell lung cancer. J Oncol 56(4):394–400
28.
Sas-Korczynska B, Sokolowski A, Korzeniowski S (2013) The influence of time of radio-chemotherapy and other therapeutic factors on treatment results in patients with limited disease small cell lung cancer. Lung Cancer 79:14–19CrossRefPubMed
29.
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J (2008) Fleischner Society: Glossary of terms for thoracic imaging. Radiology 246:697–722CrossRefPubMed
30.
Graham MV, Purdy JA, Emami B, Harms W, Bosch W et al (1999) Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 45:323–329CrossRefPubMed
31.
Hernando ML, Marks LB, Bentel GC, Zhou SM, Hollis D et al (2011) Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys 51:650–659CrossRef
32.
Bradley JD, Hope A, El Naqa I, Apte A, Lindsay PE et al (2007) A normogram to predict radiation pneumonitis, derived from a combined analysis of RTOG 9311 and institutional data. Int J Radiat Oncol Biol Phys 69:985–992CrossRefPubMedPubMedCentral
33.
Mehta V (2005) Radiation pneumonitis and pulmonary fibrosis in non-small-cell lung cancer: pulmonary function, prediction and prevention. Int J Radiat Oncol Biol Phys 63:5–24CrossRefPubMed
34.
Rodrigues G, Lock M, D’Souza D, Yu E, Van Dyk J (2004) Prediction of radiation pneumonitis by dose-volume histogram parameters in lung cancer – A systematic review. Radiother Oncol 71:127–138CrossRefPubMed
35.
Roeder F, Friedrich J, Timke C, Kappes J, Huber P et al (2010) Correlation of patient-related factors and dose-volume histogram parameters with the onset of radiation pneumonitis in patients with small cell lung cancer. Strahlenther Onkol 186:149–156CrossRefPubMed
36.
Hope AJ, Lindsay PE, El Naqa T, Alaly JR, Vicic M et al (2006) Modeling radiation pneumonitis risk with clinical, dosimetric, and spatial parameters. Int J Radiat Oncol Biol Phys 65:112–124CrossRefPubMed
37.
Schneider RA, Schultze J, Jensen JM, Hebbinghaus D, Galalae R, Kimmig BN (2007) 20 years of experience in static intensity-modulated total body irradiation and lung toxicity. Strahlenther Onkol 183:545–551CrossRefPubMed
38.
Morgan GW, Breit SN (1995) Radiation and the lung: A reevaluation of the mechanisms mediating pulmonary injury. Int J Radiat Oncol Biol Phys 31:361–369CrossRefPubMed
39.
Willner J, Baier K, Caragiani E, Tschammler A, Flentje M (2002) Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 52:382–389CrossRefPubMed
40.
Palma DA, Senan S, Tsujino K, Barriger RB, Rengan R et al (2013) Predicting radiation pneumonitis after chemoradiotherapy for lung cancer: An international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys 85:444–450CrossRefPubMed
41.
Tsukada H, Yokoyama A, Goto K, Takada M, Saijo N, Japan Clinical Oncology Lung Cancer Study Group (2001) Concurrent versus sequential radiotherapy for small cell lung cancer. Semin Oncol 28:23–26CrossRefPubMed
42.
De Ruysscher D, Belderbos J, Reymen B, van Elmpt W, van Baardwijk A et al (2013) State of the art radiation therapy for lung cancer 2012: a glimpse of the future. Clin Lung Cancer 14:89–95CrossRefPubMed
43.
Rossi A, Martelli O, Di Maio M (2013) Treatment of patients with small-cell lung cancer: from meta-analyses to clinical practice. Cancer Treat Rev 39:498–506CrossRefPubMed
Metadata
Title
Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer
A single-centre retrospective study
Authors
Assoc. Prof. Beata Sas-Korczyńska, MD, PhD
Elżbieta Łuczyńska
Wojciech Kamzol
Andrzej Sokołowski
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 2/2017
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-016-1069-6

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