Thoracic radiotherapy in the treatment of limited disease of small-cell cancer: sequence and fractionation.
Since two meta-analyses showed improved survival rates at 3 years of approximately 5%, thoracic radiotherapy is accepted as an essential component of optimal management of limited-disease. However, optimal sequencing, timing, fractionation, dose, and field size still remain a matter of controversy. The issue has changed since the traditional doxorubicin-based chemotherapy has been substituted by cisplatin based regimens which clearly produce less acute toxicity and allow concomitant chemoradiation protocols. Up-front radiotherapy seems to improve 5-years survival rates compared to the traditional sequential modality. Different fractionation schedules and escalated total doses are tested prospectively in order to reduce the intrathoracic relapse rate. Increased intensity of intrathoracic radiotherapy seems to augment long term survival rates.
Wendt
T G
TG
Department of Radiation Oncology, Friedrich-Schiller-University, Bachstrasse 18, D-07743, Jena, Germany. thomas.wendt@med.uni-jena.de
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D015996:Survival Rate; D013997:Time Factors