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Final report of a prospective randomized study on thoracic radiotherapy target volume for limitedāstage small cell lung cancer with radiation dosimetric analyses
- Source :
- Cancer. 126:840-849
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Background The thoracic radiotherapy (TRT) target volume for limited-stage small-cell lung cancer (SCLC) has been controversial for decades. In this report, the final results of a prospective randomized trial on the TRT target volume before and after induction chemotherapy are presented. Methods After 2 cycles of etoposide and cisplatin, patients arm were randomized to receive TRT to the postchemotherapy or prechemotherapy tumor volume in a study arm and a control arm. Involved-field radiotherapy was received in both arms. TRT consisted of 1.5 grays (Gy) twice daily in 30 fractions to up to a total dose of 45 Gy. Lymph node regions were contoured, and intentional and incidental radiation doses were recorded. Results The study was halted early because of slow accrual. Between 2002 and 2017, 159 and 150 patients were randomized to the study arm or the control arm, respectively; and 21.4% and 19.1% of patients, respectively, were staged using positron emission tomography/computed tomography (P = .31). With a median follow-up of 54.1 months (range, 19.9-165.0 months) in survivors, the 3-year local/regional progression-free probability was 58.2% and 65.5% in the study and control arms, respectively (P = .44), and the absolute difference was -7.3% (95% CI, -18.2%, 3.7%). In the study and control arms, the median overall survival was 21.9 months and 26.6 months, respectively, and the 5-year overall survival rate was 22.8% and 28.1%, respectively (P = .26). Grade 3 esophagitis was observed in 5.9% of patients in the study arm versus 15.5% of those in the control arm (P = .01). The isolated out-of-field failure rate was 2.6% in the study arm versus 4.1% in the control arm (P = .46), and all such failures were located in the supraclavicular fossa or contralateral hilum. The regions 7, 3P, 4L, 6, 4R, 5, and 2L received incidental radiation doses >30 Gy. Conclusions TRT could be limited to the postchemotherapy tumor volume, and involved-field radiotherapy could be routinely applied for limited-stage SCLC.
- Subjects :
- Cancer Research
medicine.diagnostic_test
business.industry
medicine.medical_treatment
Induction chemotherapy
Hilum (biology)
medicine.disease
law.invention
Radiation therapy
03 medical and health sciences
0302 clinical medicine
medicine.anatomical_structure
Oncology
Randomized controlled trial
law
Positron emission tomography
030220 oncology & carcinogenesis
Medicine
030212 general & internal medicine
business
Supraclavicular fossa
Lung cancer
Nuclear medicine
Etoposide
medicine.drug
Subjects
Details
- ISSN :
- 10970142 and 0008543X
- Volume :
- 126
- Database :
- OpenAIRE
- Journal :
- Cancer
- Accession number :
- edsair.doi...........b25b5fd09cceb358f06ba0cf418943d8