Author of

• 10874

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  P1.13 - Poster Session 1 - SCLC (ID 200)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10882

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    P1.13-008 - Omitting elective nodal irradiation and irradiating post-induction versus pre-induction chemotherapy tumor extent for limited-stage small cell lung cancer: an update of a prospective randomized trial (ID 3029)

    09:30 - 09:30  |  Author(s): Y.J. Xu
    • Abstract

    Background
    Thoracic radiation target volume for limited-stage small cell lung cancer (SCLC) has long been a controversial topic. This study prospectively compares the local/regional failure pattern and overall survival (OS) between limited-stage SCLC patients who received different target volumes of thoracic radiotherapy (TRT) after induction chemotherapy.

    Methods
    Patients diagnosed as limited-stage (AJCC/UICC T1-4N0-3M0) SCLC received 2 cycles of etoposide and cisplatin (EP) and were randomly assigned to receive TRT to either the post-induction tumor extent (study arm) or pre-induction chemotherapy tumor extent (control arm). Elective nodal irradiation was omitted in both arms i.e. clinical target volume-nodal included only initially involved nodal regions. TRT dosage of forty-five Gy/30Fx/19d was administered concurrently with the third cycle of EP regimen. Then, additional 3 cycles of EP consolidation were administered. Prophylactic cranial irradiation was administered to patients who achieved complete or partial remission.

    Results
    Seventy-nine and 91 patients were randomly assigned to study arm and control arm. Five patients in study arm and 1 patient in control arm developed distant metastasis before TRT and received palliative treatment. One patient in study arm developed spontaneous pneumothorax and did not receive TRT. These patients were not included in the analysis of local/regional failure. However, they were included in the analysis of OS. Median follow up time for the whole group was 15.6 months (1.1 months- 129.3 months). The local recurrence rates were 30.1% (22/73) and 33.3% (30/90) respectively (P = .73). The isolated nodal failure (INF) rates were 2.7% (2/73) and 5.6% (5/90) respectively (P = .46). All INF were developed in supraclavicular regions except for one patient developed contralateral hilum lymph node recurrence. The estimated 1 and 2-year local/regional progression free survival time were 88.6%, 82.1% and 77.3%, 63.5% respectively in study arm and control arm (P = .56). The median OS time were 23.5 months (95% CI: 15.5-31.4 months) and 25.4 months (95% CI: 19.6-31.1 months) respectively in study arm and control arm. One, three and 5-year OS rates were 79.4%, 33.6%, 22.5% and 84.0%, 34.3%, 29.1% respectively (P = .74).Figure 1

    Conclusion
    The results indicate that irradiation to the post-chemotherapy tumor extent and initially involved positive nodal regions did not increase local/regional failure. However, the sample number in this analysis did not meet the design requirements. Enrollment of patients is still in progress.