Presentation on theme: "Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li."— Presentation transcript:
Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li M.D. Ph.D. Shandong Cancer Hospital, Department of Radiation Oncology
Disclosure No conflict of interests to disclosure
Background At the time of diagnosis, 30%-40% of SCLC patients present with limited disease (LD). SCLC is characterized by a rapid doubling time,high growth fraction, and early development of widespread metastases. Patients with disease in excess of T1-2, N0 do not benefit from surgery. Concurrent chemoradiotherapy represents the standard treatment for patients with LD-SCLC.
Background Accelerated hyper-fractionated radiotherapy (45Gy with 1.5Gy twice daily in 3 weeks) Dose-escalated conventional radiotherapy (60- 70Gy with 2Gy once daily in 6 to 7 weeks ) Concurrent chemoradiotherapy have been documented as reliable schedules.
RT in SCLC 53.6%±3.3% SCLC patients need RT in every stage in the disease 45.4%±4.3% SCLC patients in the initial treatment 8.2%±1.5% SCLC patients later for recurrence or progression Local failures occur in approximately one third of patients and the outcome is still poor.
RTOG 97-12 Komaki R, et al. IJROBP. 62,342-350, 2005
Lg Field (1.8 Gy/Fx) Boost (1.8Gy Bid) Total Dose x (off cord) RTOG 97-12 Wk 1 2 3 4 5
RTOG 0239 RT compliance rate: 95 % Objective response: CR: 41%, PR: 39% 2Y OS: 36.6 % Severe hematopoietic toxicity was as high as 90% ( 15 grade 3 and 49 grade 4).
Protocol: 6 cycles of etoposide and cisplatin. Cycles 4 and 5 included concurrent higher dose TRT (30Gy/20 twice daily fractions, a 2-week break, and another 30Gy/20 twice daily fractions). NCCTG 95-20-53 Schild SE,et al. J Clin Oncol 2007, 25: 3124-3129.
Results A total of 76 assessable patients enrolled. 5-year OS rate: 24%. The locoregional failure remained a problem and grade 3 or grade (3+) toxicities were as high as 97%.
Phase III trial of concurrent thoracic radiotherapy with either first- or third-cycle chemotherapy for limited- disease small-cell lung cancer Sun jm,et al. Ann Oncol. 2013;24(8):2088-92
Results: 222 patients were randomly assigned early TRT Late TRT P-value CR 36% 38% >0.05 Median OS 24.1 26.8 >0.05 Median PFS 12.4 11.2 >0.05 Meutropenic fever 21.6% 10.2% 0.02 Conclusion: TRT starting in the third cycle of chemotherapy seemed to be noninferior to early TRT, and had a more favorable profile with regard to neutropenic fever.
Our retrospective study was to compare toxicities, disease control and survival outcomes for LD-SCLC treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) versus conventional accelerated hyper-fractionated radiotherapy. Purpose
Group A Group B Total P*P*P*P* Number of patients 4357100 Age (years) 0.078 median555756 range35-7240-7435-74 ECOG PS 0.460 0-1415192 2268 Gender 0.130 M294675 F141125 AJCC 7 stage 0.940 Ⅰ112 Ⅱ5811 ⅢAⅢAⅢAⅢA142731 ⅢBⅢBⅢBⅢB152129 Patient Characteristics
Chemotherapy Two cycles chemotherapy before TRT with EP regimen (etoposide 100mg/m2 day 1-5, and cisplatin 25mg/m2 day 1-3, 21 days per cycle) were delivered. Then adjuvant chemotherapy were administered after completion of thoracic radiotherapy. Chemotherapy was administered every 3 weeks. A total of 4-6 cycles were administered.
GTV: including the residual primary tumor and involved lymph nodes after induction chemotherapy. TDF: 1.9Gy/f @ 30f in 3 weeks, 5 days a week. CTV: defined by expanding GTV with a 0.5 cm margin and involved lymph node region. TDF: 1.7Gy/f @ 30f in 3 weeks, 5 days a week. PTV: defined by expanding CTV with a 0.5 cm margin. TDF: 1.5Gy/f @ 30f in 3 weeks, 5 days a week. SIB-IMRT protocols
Conclusions Comparing with conventional accelerated hyper- fractionated RT, SIB-IMRT for limited Disease SCLC was feasible and had the potency of improving local regional recurrence. However, the toxicity was still higher.
Acknowledgements Dr. Dan Han Dr. Tao Zhou Dr. Zhongtang Wang Dr. Hongsheng Li Prof. Yong Yin Associate Prof. Jian zhu