Abstract
Introduction
Thoracic radiotherapy (TRT) is standard of care for limited-stage small cell lung
cancer (LS-SCLC). Although initial data supported the use of twice-daily (BID) radiation
to a dose of 45 Gy, recent trials have suggested similar efficacy with daily fractionation
(QD) to a dose of 60 to 70 Gy. This study evaluates trends in treatment regimen in
patients treated with TRT for LS-SCLC.
Materials and Methods
The National Cancer Database (NCDB) was queried for patients with LS-SCLC treated
with TRT between 2004 to 2017 grouped by RT fractionation QD vs. BID. Exclusion criteria
were unknown stage, and unknown RT dose. Multivariable (MVA) analyses using logistic
regression were performed to investigate factors associated with receipt of a specific
fractionation schedule.
Results
A total of 17,453 patients met inclusion criteria, with 4,996 receiving BID treatment
and 12,457 receiving QD treatment. The most common QD dose was 60 Gy (48.9%). Overall,
QD fractionation has increased (1.3%/year). In 2004, 45 Gy BID treatment (41.4%) was
the dominant fractionation. By 2017, 60 Gy QD (45.2%) increased (1.9%/y) to be the
dominant fractionation, while 45 Gy BID (24.8%) decreased (-1.4%/y) to be the second
most common fractionation. On MVA, factors that affect 1 treatment over the other
were further stratified.
Conclusion
Since 2004, QD fractionation has been the preferred TRT regimen for patients with
LS-SCLC compared to BID fractionation, with the proportion of patients getting QD
treatment continuing to increase. The choice of treatment regimen appears to be influenced
by both patient and facility characteristics.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Lung CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- NCCN guidelines insights: small cell lung cancer, version 2.2018.J Nat Compre Cance Netw. 2018; 16: 1171-1182
- A meta-analysis of thoracic radiotherapy for small-cell lung cancer.New Eng J Med. 1992; 327: 1618-1624
- Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide.New Eng J Med. 1999; 340: 265-271
- Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial.Lancet Oncol. 2017; 18: 1116-1125
- Phase 3 comparison of high-dose once-daily (QD) thoracic radiotherapy (TRT) with standard twice-daily (BID) TRT in limited stage small cell lung cancer (LSCLC): CALGB 30610 (Alliance)/RTOG 0538.J Clin Oncol. 2021; 39 (suppl, 8505)
- The National Cancer Data Base: a powerful initiative to improve Cancer Care in the United States.Ann Surg Oncol. 2008; 15: 683-690
- Radiation therapy for small cell lung cancer: an ASTRO clinical practice guideline.Pract Rad Oncol. 2020; 10: 158-173
- Radiation dose and fractionation for limited-stage small-cell lung cancer: survey of US radiation oncologists on practice patterns.Clin Lung Cancer. 2019; 20: 13-19
- Barriers to combined-modality therapy for limited-stage small cell lung cancer.JAMA Oncol. 2018; 4 (e174504-e)
- Hospital volume predicts guideline-concordant care in Stage III Esophageal Cancer.Ann Thorac Surg. 2022; 114 (Epub 2021 Sep 3): 1176-1182https://doi.org/10.1016/j.athoracsur.2021.07.092
- Disparities in receiving guideline-concordant treatment for lung cancer in the United States.Ann Am Thor Soc. 2020; 17: 186-194
- Once daily versus twice-daily radiotherapy in the management of limited disease small cell lung cancer–Decision criteria in routine practise.Radiother Oncol. 2020; 150: 26-29
- Utilization of Hyperfractionated radiation in small-cell lung Cancer and its impact on survival.J Thorac Oncol. 2015; 10: 1770-1775
Article info
Publication history
Published online: February 06, 2023
Accepted:
February 1,
2023
Received in revised form:
January 18,
2023
Received:
November 7,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
M.K. and C.L. contributed equally to this work as first authors.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
