Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Nov;18(6):675-681.e1.
doi: 10.1016/j.cllc.2017.03.009. Epub 2017 Mar 16.

Outcomes of Stereotactic Body Radiotherapy for T1-T2N0 Small Cell Carcinoma According to Addition of Chemotherapy and Prophylactic Cranial Irradiation: A Multicenter Analysis

Vivek Verma  1 , Charles B Simone 2nd  2 , Pamela K Allen  3 , Steven H Lin  4
Affiliations
Multicenter Study

Outcomes of Stereotactic Body Radiotherapy for T1-T2N0 Small Cell Carcinoma According to Addition of Chemotherapy and Prophylactic Cranial Irradiation: A Multicenter Analysis

Vivek Verma et al. Clin Lung Cancer. 2017 Nov.

Abstract

Background: Although T1-T2N0 non-small cell lung cancer can be managed with stereotactic body radiotherapy (SBRT) alone, this management has often been extrapolated to T1-T2N0 small cell lung cancer (SCLC). This secondary analysis of a multi-institutional cohort study investigated whether the addition of chemotherapy and prophylactic cranial irradiation (PCI) improved the outcomes for these patients.

Materials and methods: All cases of histologically confirmed T1-T2N0M0 SCLC were obtained from 24 institutions' prospectively collected SBRT databases. The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed. We used Kaplan-Meier analysis to evaluate the survival outcomes. Univariate and multivariate analyses identified the predictors of outcomes.

Results: From 24 institutions, 76 lesions were treated in 74 patients (median follow-up, 18 months). Chemotherapy and PCI were delivered in 56% and 23% of cases, respectively. The median SBRT dose per fraction was 50 Gy/5 fractions. Patients receiving chemotherapy experienced increased median disease-free survival (61.3 vs. 9.0 months; P = .02) and overall survival (31.4 vs. 14.3 months; P = .02). Chemotherapy independently predicted for better outcomes for disease-free survival and overall survival on multivariate analysis (P = .01). Toxicities were uncommon; 5.2% experienced grade ≥ 2 pneumonitis. Post-treatment failures were most commonly distant (45.8% of recurrences), followed by nodal (25.0%), and elsewhere in the lung (20.8%). The median time to each was 5 to 7 months.

Conclusion: Patients undergoing primary SBRT for T1-T2N0 SCLC should also undergo additional chemotherapy. No established role was found for PCI in this population.

Keywords: PCI; SABR; SBRT; SCLC; Stereotactic ablative radiotherapy.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

SHL has research funding from Elekta, STCube Pharmaceuticals, Peregrine, and Roche/Genentech, has served as a consultant for AstraZeneca, and received honorarium from US Oncology and ProCure, although all are irrelevant to this study. All other authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves of overall survival (A & B) and disease-free survival (C & D) when stratifying for receipt of chemotherapy (A, C) and prophylactic cranial irradiation (B, D).
See this image and copyright information in PMC

References

    1. National Comprehensive Cancer Network. Non-Small Cell Lung Cancer. Version 1.2016 http://www.nccn.org/professionals/physician_gls/PDF/nsclc.pdf Accessed March 24, 2016.
    1. Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 2010;303(11):1070–1076. - PMC - PubMed
    1. Simone CB 2nd, Wildt B, Haas AR, Pope G, Rengan R, Hahn SM. Stereotactic body radiation therapy for lung cancer. Chest 2013;143(6):1784–1790. - PubMed
    1. Verma V Stereotactic radiotherapy versus surgery for early-stage operable lung cancer: more questions than answers. J Natl Compr Canc Netw 2015;13(10):1293–1295. - PubMed
    1. Simone CB 2nd, Dorsey JF. Additional data in the debate on stage I non-small cell lung cancer: surgery versus stereotactic ablative radiotherapy. Ann Transl Med 2015;3(13):172. - PMC - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources