Radiation therapy in small cell lung cancer: a national Italian survey
- 51 Downloads
Radiation therapy plays an important role in the management of SCLC both in curative and palliative setting, however, conflicting data from clinical trials incite debate over the appropriate use of radiation therapy regarding prophylactic cranial irradiation (PCI) and/or thoracic consolidative in extensive-stage SCLC (ES-SCLC). This survey is conducted to evaluate the current pattern of care among Italian radiation oncologists.
In June 2016, all Italian radiation oncologists were invited to a web-based survey. The survey contained 34 questions regarding the role of RT in SCLC. Questions pertaining the role of RT in the clinical management of both limited-stage (LS) and ES-SCLC were included.
We received 48 responses from Italian radiation oncologists. More than half of respondents had been practicing for more than 10 years after completing residency training and 55% are subspecialists in lung cancer. Preferred management of LS-SCLC favored primary concurrent chemoradiotherapy (89%), even if the 36.9% usually delivered RT during or after the cycle 3 of chemotherapy, due to organizational issues. The most common dose and fractionation schedule in this setting was 60 Gy in 30 once-daily fractions. Furthermore, almost all respondents recommended PCI in patients with LS-SCLC. For ES-SCLC scenario, chemotherapy was defined the standard treatment by all respondents. PCI was recommended in ES-SCLC patients with thoracic complete remission (63% of respondents), with thoracic partial response (45%) and with thoracic stable disease (17%) after first-line chemotherapy. Lastly, the thoracic consolidative RT was recommended by 51% of respondents in patients with ES-SCLC in good response after first-line chemotherapy and a great variability was shown in clinical target volume definition, doses and fractionation schedules.
Our analysis showed a high adherence to current guidelines among the respondents in regard to chemoradiation approach in LS-SCLC patients and to PCI indications and doses. The great variability in radiation therapy doses and volumes in the thoracic consolidative radiotherapy in ES-SCLC is concerning. Future clinical trials are needed to standardize these treatment approaches to improve treatment outcomes among patients with ES-SCLC.
KeywordsRadiation therapy Small cell lung cancer National Italian survey
Compliance with ethical standards
Conflict of interest
All authors disclose no actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations that could inappropriately influence their work.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 14.Spiro SG, James LE, Rudd RM, on behalf of the London Lung Cancer Group et al (2006) Early compared with late radiotherapy in combined modality treatment for limited disease small cell lung cancer: a London Lung Cancer Group multicenter randomized clinical trial and meta-analysis. J Clin Oncol 24:3823–3830CrossRefPubMedGoogle Scholar
- 16.Salama JK, Hodgson L, Pang H, on behalf of Cancer and Leukemia Group B et al (2013) A pooled analysis of limited-stage small cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy: calgb 30904. J Thorac Oncol 8:1043–1049CrossRefPubMedGoogle Scholar
- 17.Komaki R, Paulus R, Ettinger DS et al (2012) Phase II study of accelerated high-dose radiotherapy with concurrent chemotherapy for patients with limited small-cell lung cancer: Radiation Therapy Oncology Group protocol 0239. Int J Radiat Oncol Biol Phys 83:e531–e536CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Faivre-Finn C, Snee M, Ashcroft L et al (2016) CONVERT: an international randomised trial of concurrent chemo-radiotherapy comparing twice-daily and once-daily radiotherapy schedules in patients with limited stage small cell lung cancer and good performance status. In: 2016 ASCO annual meeting. Abstract 8504Google Scholar
- 24.Le Pèchoux C, Dunant A, Senan S et al (2009) Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01): a randomised clinical trial. Lancet Oncol 10:467–474CrossRefPubMedGoogle Scholar
- 27.Gondi V, Paulus R, Bruner DW et al (2013) Decline in tested and self-reported cognitive functioning after prophylactic cranial irradiation for lung cancer: pooled secondary analysis of Radiation Therapy Oncology Group randomized trials 0212 and 0214. Int J Radiat Oncol Biol Phys 86:656–664CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Seto T, Takahashi T, Yamanaka T et al (2014) Prophylactic cranial irradiation (PCI) has a detrimental effect on the overall survival (OS) of patients (pts) with extensive disease small cell lung cancer (ED-SCLC): results of a Japanese randomized phase III trial [abstract 7503]. J Clin Oncol 32:5sCrossRefGoogle Scholar
- 29.Sharma S, McMillan MT, Doucette A et al (2017) Effect of prophylactic cranial irradiation on overall survival in metastatic small-cell lung cancer: a propensity score-matched analysis. Clin Lung Cancer. https://doi.org/10.1016/j.cllc.2017.12.003
- 39.Nabivizadeh N, Elliott DA, Chen Y et al (2016) Image guided radiation therapy (IGRT) practice patterns and IGRT’s impact on workflow and treatment planning: results from a national survey of American Society for Radiation Oncology members. Int J Radiat Oncol Biol Phys 94:850–857CrossRefGoogle Scholar