Tumour size reduction after the first chemotherapy-course and outcomes of chemoradiotherapy in limited disease small-cell lung cancer

Lung Cancer. 2016 Dec:102:9-14. doi: 10.1016/j.lungcan.2016.10.003. Epub 2016 Oct 15.

Abstract

Objectives: Concurrent chemotherapy and thoracic radiotherapy (TRT) is recommended for limited disease small-cell lung cancer (LD SCLC). TRT should start as early as possible, often meaning with the second course due to patient referral time and the fact that TRT planning takes time. Early assessment of response to the first course of chemotherapy may be a useful way to individualise treatment. The aims of this study were to assess tumour size reduction after the first chemotherapy-course, and whether this reduction was associated with outcomes in LD SCLC.

Material and methods: A randomised trial comparing twice-daily (45Gy/30 fractions) with once-daily (42Gy/15 fractions) TRT, given concurrently with four courses of cisplatin/etoposide (n=157) was the basis for this study. Tumour size was assessed on CT scans at baseline and planning scans for TRT according to RECIST 1.0.

Results: CT scans were available for 135 patients (86%). Ninety-four percent had a reduction in tumour size after the first chemotherapy-course. The median reduction in sum of diameters (SOD) of measurable lesions was ÷16mm (÷84 to +10mm), corresponding to ÷18% (÷51 to +12%). Eighty-two percent had stable disease, 18% partial response. Reduction in SOD was significantly associated with complete response at first follow-up (OR: 1.05, 95% CI 1.01-1.09; p=0.013), PFS (HR: 0.97, 95% CI 0.96-0.99; p=0.001), and overall survival (HR: 0.98, 95% CI 0.96-1.00; p=0.010).

Conclusion: Response from the first course of chemotherapy had a significant positive association with outcomes from chemoradiotherapy, and might be used to stratify and randomise patients in future studies.

Keywords: Chemotherapy; Concurrent; Early response; Predictive; Radiotherapy; Survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chemoradiotherapy / methods*
  • Combined Modality Therapy
  • Disease-Free Survival
  • Drug Therapy / standards*
  • Female
  • Humans
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Norway / epidemiology
  • Radiotherapy Dosage
  • Randomized Controlled Trials as Topic
  • Remission Induction
  • Small Cell Lung Carcinoma / diagnostic imaging
  • Small Cell Lung Carcinoma / drug therapy*
  • Small Cell Lung Carcinoma / pathology
  • Small Cell Lung Carcinoma / radiotherapy*
  • Survival Analysis
  • Symptom Assessment / methods*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tumor Burden / drug effects*