High-Dose Involved Field Radiotherapy and Concurrent Chemotherapy for Limited-Disease Small Cell Lung Cancer

ABSTRACT

PURPOSE: We wanted to evaluate the effect of high dose involved field radiotherapy and concurrent chemotherapy for treating patients with limited disease, small cell lung cancer. MATERIALS AND METHODS: We reviewed the medical records of 37 patients who had a limited stage of small cell lung cancer. All the patients were treated with induction chemotherapy followed by definitive radiotherapy and concurrent chemotherapy. The radiation dose was 60 Gy for 31 patients and 50~58 Gy for 6 patients with once-daily 2 Gy fractions. Elective nodal irradiation was not performed. The chemotherapy regimen was either combinations of etoposide and cisplatin or irinotecan and cisplatin. Prophylactic cranial irradiation of 25 Gy at 2.5 Gy per fraction was administered to the patients who had a complete or near complete response. The median follow-up period was 17 months (range, 5~57). RESULTS: The 2-year overall survival and locoregional control rates were both 55%. A complete response was achieved in 17 patients (46%), a partial response was achieved in 19 patients (51%) and 1 patient (3%) had progressive disease. Seven patients experienced tumor recurrence in the radiation field and four of those recurrences were isolated local recurrences. There was only one isolated regional recurrence outside the radiation field. Grade 3 treatment-related esophageal toxicity occurred in 2 patients. Two patients died of treatment-related pulmonary complications. CONCLUSION: Involved field radiotherapy of 60 Gy can achieve favorable survival and a low rate of isolated nodal failure outside the radiation field. However, a considerable number of patients still experienced in-field failure. Further studies to establish the optimal radiation doses and fractionation are needed in the future.