title: Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer : A single-centre retrospective study.
abstract: BACKGROUND
  The most effective therapy in patients with limited-stage small cell lung cancer (LS SCLC) seems to be chemotherapy (using platinum-based regimens) and thoracic radiotherapy (TRT), which is followed by prophylactic cranial irradiation.
  
  
  METHODS
  The analysed group comprised 217 patients who received combined treatment for LS SCLC, i.e. chemotherapy (according to cisplatin and etoposide schedule) and TRT (concurrent in 101 and sequential in 116 patients). The influence of chemoradiotherapy (ChT-RT) schedule on treatment results (frequency of complete response, survival rates, and incidence of treatment failure and complications) was evaluated, and the frequency and severity of pulmonary complications were analysed to identify risk factors.
  
  
  RESULTS
  The 5‑year survival rates in concurrent vs. sequential ChT-RT schedules were 27.3 vs. 11.7% (overall) and 28 vs. 14.3% (disease-free). The frequencies of adverse events in relation to concurrent vs. sequential therapy were 85.1 vs. 9.5% (haematological complications) and 58.4 vs. 38.8% (pulmonary fibrosis), respectively. It was found that concurrent ChT-RT (hazard ratio, HR 2.75), a total dose equal to or more than 54 Gy (HR 2.55), the presence of haematological complications (HR 1.89) and a lung volume receiving a dose equal to or greater than 20 Gy exceeding 31% (HR 1.06) were the risk factors for pulmonary complications.
  
  
  CONCLUSIONS
  Pulmonary complications after ChT-RT developed in 82% of patients treated for LS SCLC. In comparison to the sequential approach, concurrent ChT-RT had a positive effect on treatment outcome. However, this is a factor that can impair treatment tolerance, which manifests in the appearance of side effects.
authors: Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland. z5korczy@cyf-kr.edu.pl.
authors: Beata
authors: B
authors: Sas-Korczyńska
authors: Department of Diagnostic Radiology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
authors: Elżbieta
authors: E
authors: Łuczyńska
authors: Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
authors: Wojciech
authors: W
authors: Kamzol
authors: Department of Statistics, Cracow University of Economics, Rakowicka 27, 31-510, Cracow, Poland.
authors: Andrzej
authors: A
authors: Sokołowski
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000401:mortality* / Q000706:statistics & numerical data; D015897:Comorbidity; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D017564:Radiation Pneumonitis / Q000401:mortality* / Q000517:prevention & control; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Chemoradiotherapy; Limited-stage small cell lung cancer; Pulmonary complications; Pulmonary fibrosis; Survival