Cancer Res Treat.  2023 Jan;55(1):73-82. 10.4143/crt.2021.1202.

Analysis of Once-Daily Thoracic Radiotherapy Dose According to the Underlying Lung Disease in Patients with Limited-Stage Small Cell Lung Cancer Undergoing Concurrent Chemoradiotherapy

• Kim BH
• Chung JH
• Son J
• Kim S
• Wu HG
• Kim HJ

• KMID: 2537993
• DOI: http://doi.org/10.4143/crt.2021.1202

Abstract

Purpose
In the treatment of concurrent chemoradiotherapy (CCRT) in limited-stage small cell lung cancer, the optimal once-daily radiotherapy (RT) dose/fractionation remain unclear although it is the most frequently used. Therefore, this study aimed to compare the treatment outcomes and toxicities of modest dose RT (≤ 54 Gy) with those of standard dose RT (> 54 Gy) and investigate the benefit of the high dose based on patient factors.
Materials and Methods
Since 2004, our institution has gradually increased the thoracic RT dose. Among the 225 patients who underwent CCRT, 84 patients (37.3%) received > 54 Gy. Because the patients treated with RT > 54 Gy were not randomly assigned, propensity score matching (PSM) was performed.
Results
The proportion of patients treated with > 54 Gy increased over time (p=0.014). Multivariate analysis revealed that the overall tumor stage and dose > 54 Gy (hazard ratio, 0.65; p=0.029) were independent prognostic factors for overall survival (OS). PSM confirmed that thoracic RT doses of > 54 Gy showed significantly improved progression-free survival (3-year, 42.7% vs. 24.0%; p < 0.001) and OS (3-year, 56.2% vs. 38.5%; p=0.003). Sensitivity analysis also showed that 60 Gy resulted in better survival than 54 Gy. However, in patients with underlying lung disease, OS benefit from > 54 Gy was not observed but considerable rates of severe pulmonary toxicities were observed (p=0.001).
Conclusion
Our analysis supports that the 60 Gy RT dose should be considered in the once-daily regimen of CCRT for limited-stage small cell lung cancer without underlying lung disease, but RT dose > 54 Gy did not seem to benefit for patients with chronic obstructive pulmonary disease or interstitial lung disease. Further study is needed to validate these results.

Keyword

Small-cell lung carcinoma; Radiotherapy; Underlying lung disease

Figure

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  Fig. 1 Kaplan-Meier graph by thoracic radiotherapy dose in propensity score matched patients: (A) progression-free survival (PFS) and (B) overall survival (OS).

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  Fig. 2 Exploratory subgroup analysis on overall survival evaluating the benefit of 60 Gy or higher thoracic radiotherapy dose during once-daily concurrent chemoradiotherapy. BMI, body mass index; COPD, chronic obstructive pulmonary disease; CTx, chemotherapy; ECOG, Eastern Cooperative Oncology Group; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; ILD, interstitial lung disease; PCI, prophylactic cranial irradiation.

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  Fig. 3 Overall survival (OS) graph in each lung disease group according to the thoracic radiotherapy dose in matched cohort (≤ 54 Gy and > 54 Gy): (A) without lung disease, (B) chronic obstructive pulmonary disease (COPD), and (C) interstitial lung disease (ILD).

Reference

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