Firsthand experience of chemoradiotherapy in patients with localized small cell lung cancer. Retrospective assessment

Abstract

Introduction. In modern recommendations for the treatment of localized small cell lung cancer (SCLC), preference is given to socalled «early» chemoradiotherapy (CRT), which has a number of limitations due to its pronounced toxicity. With regard to prophylactic brain irradiation (PBI), although there is reliable evidence that it is necessary, PBI cannot be performed on all patients due to the frequent refusals of the patients themselves and the accompanying neurological pathology. The article presents own experience of therapy of patients with localized SCLC with the analysis of accumulated data. Materials and methods. Retrospective assessment of treatment results of patients with localized SCLC was carried out. The analysis included data on 63 patients. 47 patients received simultaneous CRT and 16 patients received consecutive CRT. The results of simultaneous CRT were evaluated first. 27 patients received “early” CRT, while 20 patients received “late” CRT. Results. The PFS median for the group of early CRT was 9.5 months (95% CI 4.2–14.9) and for the group of “late” CRT it was 11.8 months (6.4–17.1). The difference is statistically unreliable. The median of total survival rate was higher in the group of “early” CRT, despite the fact that PFS was lower. The OS median in the group of “early” CRT was 27.9 months (95% CI 2.1–53.7), and in the group of “late” – 24.8 months (95% CI 13.3–36.1). The difference is statistically unreliable. Prophylactic brain irradiation (PBI) in the group of patients with simultaneous CRT was received by 26 patients (55%). The results of overall survival show the crucial importance of PBI in patients with localized SCLC. The OS median in patients who received PBI was 45.9 months (95% CI 21.2–70.5), in patients who did not receive PBI – 21.7 months (95% CI 14.3–29). The difference is statistically significant, p = 0.01. As for complications, 2nd degree esophagitis was recorded more frequently in the group of early CRT – 57% in the group of early CRT and 42% in the group of late CRT, 3rd degree esophagitis was recorded in 1 patient in each group, the difference is not significant. Grade 3–4 hematological toxicity was observed in 5 patients in the group of early CRT and 2 patients in the group of late CRT, the difference is also unreliable. The OS median in the group of patients who received consecutive CRT was 27.1 months (95% CI 18.2–37.6), and the OS median in the group of patients who received simultaneous CRT was 27.9 months (95% CI 18.9–36.9). Conclusions. The obtained data show an unreliable advantage of the “early” CRT over the “late” CRT in terms of overall survival. However, no differences in median time before progression of both local and general ones were obtained. It is extremely important to perform PBI in patients with localized SCLC, as the survival rate in the assessed group of patients doubled.

Keywords

• localized small cell lung cancer
• prophylactic brain irradiation
• early chemoradiotherapy
• late chemoradiotherapy
• simultaneous chemoradiotherapy
• consecutive chemoradiotherapy