title: 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.
abstract: BACKGROUND
  Standard therapy for limited-stage small-cell lung cancer (L-SCLC) is concurrent chemotherapy and radiotherapy (RT) followed by prophylactic cranial radiotherapy. Although many consider the standard RT regimen to be 45 Gy in 1.5 Gy twice-daily fractions, this has failed to gain widespread acceptance. We pooled data of patients assigned to receive daily RT of 70 Gy from three, consecutive prospective Cancer and Leukemia Group B L-SCLC cancer trials and report the results here.
  
  
  METHODS
  All patients from consecutive Cancer and Leukemia Group B L-SCLC trials (39808, 30002, and 30206) using high-dosage daily RT with concurrent chemotherapy were included, and analyzed for toxicity, disease control, and survival. Overall survival (OS) and progression-free survival (PFS) were modeled using Cox proportional hazards models. Prognostic variables for OS-rate and PFS-rate were assessed using logistic regression model.
  
  
  RESULTS
  Two hundred patients were included. The median follow-up was 78 months. Grade 3 or greater esophagitis was 23%. The median OS for pooled population was 19.9 months (95% confidence interval [CI]: 16.7-22.3), and 5-year OS rate was 20% (95% CI: 16-27%). The 2-year PFS was 26% (95% CI: 21-32%). Multivariate analysis found younger age (p = 0.02; hazard ratio [HR]: 1.023; 95% CI: 21-32), and female sex (p = 0.02; HR:0.69; 95% CI: 0.50-0.94) independently associated with improved overall survival.
  
  
  CONCLUSIONS
  Two-Gy daily RT to a total dosage of 70 Gy was well tolerated with similar survival to 45 Gy (1.5 Gy twice-daily). This experience may aid practitioners decide whether high-dosage daily RT with platinum-based chemotherapy is appropriate outside of a clinical trial.
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Box 3085, Durham, North Carolina 27710, USA. joseph.salama@duke.edu
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.forename: Lydia
authors.initials: L
authors.lastname: Hodgson
authors.forename: Herbert
authors.initials: H
authors.lastname: Pang
authors.forename: James J
authors.initials: JJ
authors.lastname: Urbanic
authors.forename: A William
authors.initials: AW
authors.lastname: Blackstock
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bogart
authors.forename: Everett E
authors.initials: EE
authors.lastname: Vokes
mesh_terms: D000328:Adult; D000368:Aged; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy; D016371:Cranial Irradiation; D018450:Disease Progression; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010984:Platinum / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000628:therapy*
chemical_list: D010984:Platinum; D016190:Carboplatin