title: Predictors of pulmonary toxicity in 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 followed by prophylactic cranial radiotherapy. Predictors of post chemoradiotherapy pulmonary toxicity in limited stage (LS) small cell lung cancer (SCLC) patients are not well defined. Current guidelines are derived from non-small cell lung cancer regimens, and do not account for the unique biology of this disease. Therefore, we analyzed patients on three consecutive CALGB LS-SCLC trials treated with concurrent chemotherapy and daily high dose radiotherapy (70 Gy) to determine patient and treatment related factors predicting for post-treatment pulmonary toxicity.
  
  
  METHODS
  Patients treated on CALGB protocols 39808, 30002, 30206 investigating two cycles of chemotherapy followed by concurrent chemotherapy and 70 Gy daily thoracic radiation therapy were pooled. Patient, tumor, and treatment related factors were evaluated to determine predictors of grade 3–5 pulmonary toxicities after concurrent chemoradiotherapy.
  
  
  RESULTS
  100 patients were included. No patient experienced grade 4–5 post-treatment pulmonary toxicity. Patients who experienced post-treatment pulmonary toxicity were more likely to be older (median age 69 vs 60, p = 0.09) and have smaller total lung volumes (2565 cc vs 3530 cc, p = 0.05).). Furthermore,exposure of larger volumes of lung to lower (median V5 = 70%, p = 0.09, median V10 = 63%, p = 0.07), inter-mediate (median V20 = 50, p = 0.04) and high (median V60 = 25%, p = 0.01) doses of radiation were all associated with post-treatment grade 3 pulmonary toxicity, as was a larger mean lung radiation dose(median 31 Gy) p = 0.019.
  
  
  CONCLUSIONS
  Post-treatment pulmonary toxicity following the completion of 2 cycles of chemotherapy followed by concurrent chemotherapy and high dose daily radiation therapy was uncommon. Care should be taken to minimize mean lung radiation exposure, as well as volumes of low, intermediate and high doses of radiation.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.forename: Herbert
authors.initials: H
authors.lastname: Pang
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bogart
authors.forename: A William
authors.initials: AW
authors.lastname: Blackstock
authors.forename: James J
authors.initials: JJ
authors.lastname: Urbanic
authors.forename: Lydia
authors.initials: L
authors.lastname: Hogson
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.forename: Everett E
authors.initials: EE
authors.lastname: Vokes
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017671:Platinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D017671:Platinum Compounds