Comparison of survival outcomes among standard radiotherapy regimens in limited-stage small cell lung cancer patients receiving concurrent chemoradiation.
OBJECTIVE
The optimal radiotherapy dose in concurrent chemoradiation (CRT) for limited-stage small cell lung cancer (SCLC) is controversial. We compared the effectiveness of several high-dose chemoradiation regimens using a large national dataset.


METHODS
Patients with non-metastatic SCLC treated with concurrent CRT were identified in the National Cancer Database base. Overall survival (OS) of patients receiving dose-fractionation regimens, matching those in the ongoing CALGB 30610 trial [45 Gy in 30 fractions (Fx) (45 Gy/30Fx), 70 Gy in 35 fractions (70 Gy/35Fx), and 61.2 Gy in 34 fractions (61.2 Gy/34Fx)], were compared using Kaplan-Meier analysis and multivariable Cox proportional hazards modeling.


RESULTS
We included 1228 patients treated between 1998 and 2006 with CRT. Mean age was 62 years and 50% of patients were women. Radiotherapy dose-fractionation was 45 Gy/30Fx in 707 (57.6%), 70 Gy/35Fx in 53 (4.3%), and 61.2 Gy/34Fx in 468 (38.1%). Overall survival was similar among patients treated with 45 Gy/30Fx, 70 Gy/35Fx, and 61.2 Gy/34Fx, with median survival times of 21.5, 21.5, and 20.2 months, respectively (p=0.438). Older age, male sex, larger tumor size, and more advanced stage were associated with inferior OS on Kaplan-Meier (all p<0.001). Cox proportional hazards modeling adjusting for these factors demonstrated similar OS among patients receiving these three dose-fractionation regimens (p=0.815).


CONCLUSIONS
We observed equivalent OS among patients with limited-stage SCLC being treated with three dose-fractionation regimens of concurrent CRT. This supports the use of any one of these regimens while awaiting the results of ongoing randomized trials.
Departments of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA. Electronic address: charles.rutter@yale.edu.
Charles E
CE
Rutter
Departments of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA.
Henry S
HS
Park
Departments of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA.
Christopher D
CD
Corso
Departments of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA.
Debra N
DN
Yeboa
Departments of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA.
Brandon R
BR
Mancini
Departments of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA.
Nataniel H
NH
Lester-Coll
Thoracic Surgery, Yale School of Medicine, New Haven, CT 06510, USA.
Anthony W
AW
Kim
Departments of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, USA.
Roy H
RH
Decker
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*
Dose; Fractionation; Limited; NCDB; Radiotherapy; Small Cell