Concurrent hyperfractionated radiotherapy and chemotherapy for patients with limited small-cell lung cancer. Results from a single institution

Abstract

Background

Concurrent use of chemotherapy and twice-a-day hyperfractionated radiotherapy is an efficacious scheme to control limited disease (LD) small-cell lung cancer (SCLC).

Aim

Our main objective was to estimate initial results in overall survival for patients with LD-SCLC treated with concomitant chemotherapy and hyperfractionated thoracic radiotherapy in routine practice. Response to treatment and toxicity were also assessed.

Material and Methods

Forty-nine patients with confirmed LD-SCLC were treated at the Department of Radiotherapy of the Hospital General de Catalonia (Spain) from December 1999 to February 2007. The chemotherapy regimen was cisplatin (80 mg/m²) on day 1 and etoposide (100 mg/m²) on days 1, 2, and 3, every 21 day. The target dose to the tumor volume was 45 Gy. Prophylactic cranial irradiation (PCI), consisting of 30 Gy delivered in 15 fractions, was prescribed for all patients with a response rate >75% (23 of 30 patients).

Results

Median follow-up was 12 months (range, 6–58 months) and median overall survival was 28.9 months. Two-year and 4-year survival rates were 56.4% and 30.1%, respectively. At 2 years, specific survival, local control, and systemic control were 64.2%, 88.8%, and 46.8%, respectively. Myelotoxicity and oesophagitis were the most severe toxicities.

Conclusions

The combined schedule – hyperfractionated irradiation plus concurrent chemotherapy – can be applied in routine practice in the context of early radiotherapy, which is considered standard treatment, with acceptable toxicity and similar results to those described in the literature.