Thoracic irradiation in 3weeks for limited-stage small cell lung cancer: Is twice a day fractionation really needed?
OBJECTIVE
Many Canadian institutions treat limited-disease small cell lung cancer with 40Gy in 15 fractions delivered once-a-day in 3weeks concomitantly with chemotherapy. This regimen is convenient and seems to be effective. Here, we report and compare with a literature review the outcomes of patients with limited-stage small cell lung cancer treated in our institution with this hypofractionated regimen.


METHODS
From January 2004 to December 2012, patients with limited-stage small cell lung cancer treated curatively with platinum-based chemotherapy and concurrent thoracic radiotherapy at a dose of 40Gy in 16 fractions once-a-day were eligible for this review.


RESULTS
Sixty-eight patients fit the analysis criteria, including ten patients with small pleural effusion. The median age was 66years old. After a median follow-up of 77months for those alive, the median survival was 28months. At 3 and 5years respectively, the locoregional control rates were 67 and 64%, while the overall survival rates were 40 and 35%. Prophylaxis cranial irradiation was delivered to 68% of the patients. Grade 2 and 3 acute esophagitis occurred in respectively 49 and 9% of the patients. There was no grade 4 radiation-induced toxicity. All patients, except for one, completed their thoracic irradiation course without interruption.


CONCLUSIONS
Once-a-day hypofractionated radiation with concurrent chemotherapy followed by prophylactic cranial irradiation is a practical regimen. Based on our experience and the published literature, it appears to be similarly effective as regimens using twice-daily fractionation in 3weeks, or once-daily in 6 to 7weeks with higher radiotherapy doses. Further prospective comparisons of hypofractionation with the current recommendations are needed.
Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
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Turgeon
Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
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Souhami
Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
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Kopek
Department of Oncology, Division of Medical Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
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Hirsh
Division of Respiratory Medicine, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada.
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Ofiara
Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1 Montreal, Quebec, Canada. Electronic address: sergio.faria@muhc.mcgill.ca.
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Faria
D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D013997:Time Factors; D016896:Treatment Outcome
Chimiothérapie concomitante; Concomitant chemoradiation; Dédoublement cellulaire rapide; Hypofractionation; Hypofractionnement; Irradiation panencéphalique prophylaxique; Prophylactic cranial irradiation; Tumor cell rapid doubling time