title: Evaluation of the role of remission status in a heterogeneous limited disease small-cell lung cancer patient cohort treated with definitive chemoradiotherapy.
abstract: BACKGROUND
  The role of remission status in limited disease (LD) small-cell lung cancer (SCLC) patients treated with definitive chemoradiotherapy (CRT) remains to be finally clarified.
  
  
  METHODS
  Individual data from 184 patients treated with definitive CRT concurrently or sequentially were retrospectively reviewed. Kaplan-Meier analysis as well as univariate and multivariate Cox regression models were used to describe survival within patient subgroups defined by remission status.
  
  
  RESULTS
  71 (39%) patients were treated in the concurrent, 113 (61%) in the sequential CRT mode. Prophylactic cranial irradiation (PCI) was applied in 71 (39%) patients. 37 (20%) patients developed local, while 89 (48%) distant recurrence. 58 (32%) patients developed metachronous brain metastases. Complete, partial remission and non-response (defined as stable and progressive disease) were documented in 65 (35%), 77 (42%), and 37 (20%) patients, respectively. In complete responders median overall survival was 21.8 months (95CI: 18.6 - 25) versus 14.9 (95% CI: 11.7 - 18.2) (p = 0.041, log-rank test) and 11.5 months (95% CI: 8.9 - 15.0) (p < 0.001, log-rank test) in partial and non-responders, respectively. The same effect was documented for the time to progression and distant metastasis-free survival. In the multivariate analysis achievement of complete remission as a variable shows a trend for the prolonged time to progression (p = 0.1, HR 1.48) and distant metastasis-free survival (p = 0.06, HR 1.63) compared to partial responders and was highly significant compared to non-responders.
  
  
  CONCLUSIONS
  In this treated heterogeneous LD SCLC patient cohort complete remission was associated with longer time to progression, distant metastasis-free and overall survival compared to the non- and especially partial responders.
authors.affiliation: Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany. Farkhad.manapov@med.uni-muenchen.de.
authors.forename: Farkhad
authors.initials: F
authors.lastname: Manapov
authors.affiliation: Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Niyazi
authors.affiliation: Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Gerum
authors.affiliation: Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Olarn
authors.initials: O
authors.lastname: Roengvoraphoj
authors.affiliation: Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Chukwuka
authors.initials: C
authors.lastname: Eze
authors.affiliation: Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Minglun
authors.initials: M
authors.lastname: Li
authors.affiliation: Radiation Oncology, University of Rostock, Südring 75, 18059, Rostock, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Radiation Oncology, Friedrich-Alexander University Erlangen-Nuernberg, Universitätsstrasse 27, 91054, Erlangen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Fietkau
authors.affiliation: Radiation Oncology, Klinikum Chemnitz, Alte Marienberger Strasse 52, 09405, Chemnitz, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Klautke
authors.affiliation: Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D059248:Chemoradiotherapy; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012074:Remission Induction; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
keywords: Chemoradiotherapy; Limited disease; Lung cancer; Remission; Small-cell