Thoracic Radiotherapy Combined with Chemotherapy in Patients with Limited-stage Small-cell Lung Cancer

ABSTRACT

PURPOSE: We evaluated the optimal combination of thoracic radiotherapy with chemotherapy in patients with limited-stage small cell lung cancer (L-SCLC). MATERIALS AND METHODS: We retrospectively analyzed the data of 95 patients with L-SCLC who completed the planned thoracic radiotherapy combined with chemotherapy between January 1998 and March 2004. Thoracic radiotherapy was done with conventional fractionation to the median dose of 60Gy. Radiotherapy was combined with chemotherapy concurrently (n=67), alternating (n=19), or sequentially (n=9). Chemotherapy consisted of EP or EC (etoposide 100 mg/m2, cisplatin 60 mg/m2 or carboplatin 5~6xAUC ). The median cycle of chemotherapy was 6 with the range of 2 to 8. RESULTS: The median survival of all 95 patients was 20 months and 2-, 3-, and 5-year overall survival rate was 39%, 26%, and 19%, respectively. Radiation dose above 55 Gy did not show better survival result than dose below 55 Gy (p=0.59). The median survival and 5-year survival rate of 67 patients with concurrent chemoradiation was 23 months and 24% while those of 28 patients with alternating or sequential chemoradiation was 16 months and 8%, respectively (p=0.007). Concurrent thoracic radiotherapy combined after 2 cycles of chemotherapy showed the best survival results among the combination methods (p=0.29). The survival was improved in patients with chemotherapy more than 5 cycles comparing to patients with less than 5 (p=0.03). Patients with PCI showed the median survival of 43 months and 5-year survival rate of 35% vs. 18 months and 16% in patients without PCI, respectively (p=0.02). In multivariate analysis, the concurrent chemoradiation was the only significant prognostic factor affecting to the survival. CONCLUSION: Concurrent chemoradiation after 2 cycles of chemotherapy showed the best survival results in our study group. Full dose of chemotherapy to 6 cycles needed to be proceeded in tolerable patients. PCI can be recommended to the patients with complete response after chemoradiation