A pooled analysis of limited-stage small-cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy

CALGB 30904

Joseph K. Salama, Lydia Hodgson, Herbert Pang, James J. Urbanic, A. William Blackstock, Steven E. Schild, Jeffrey Crawford, Jeffrey A. Bogart, Everett E. Vokes

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

INTRODUCTION: Standard therapy for limited-stage small-cell lung cancer (L-SCLC) is concurrent chemotherapy and radiotherapy (RT) followed by prophylactic cranial radiotherapy. Although many consider the standard RT regimen to be 45 Gy in 1.5 Gy twice-daily fractions, this has failed to gain widespread acceptance. We pooled data of patients assigned to receive daily RT of 70 Gy from three, consecutive prospective Cancer and Leukemia Group B L-SCLC cancer trials and report the results here. METHODS: All patients from consecutive Cancer and Leukemia Group B L-SCLC trials (39808, 30002, and 30206) using high-dosage daily RT with concurrent chemotherapy were included, and analyzed for toxicity, disease control, and survival. Overall survival (OS) and progression-free survival (PFS) were modeled using Cox proportional hazards models. Prognostic variables for OS-rate and PFS-rate were assessed using logistic regression model. RESULTS: Two hundred patients were included. The median follow-up was 78 months. Grade 3 or greater esophagitis was 23%. The median OS for pooled population was 19.9 months (95% confidence interval [CI]: 16.7-22.3), and 5-year OS rate was 20% (95% CI: 16-27%). The 2-year PFS was 26% (95% CI: 21-32%). Multivariate analysis found younger age (p = 0.02; hazard ratio [HR]: 1.023; 95% CI: 21-32), and female sex (p = 0.02; HR:0.69; 95% CI: 0.50-0.94) independently associated with improved overall survival. CONCLUSION: Two-Gy daily RT to a total dosage of 70 Gy was well tolerated with similar survival to 45 Gy (1.5 Gy twice-daily). This experience may aid practitioners decide whether high-dosage daily RT with platinum-based chemotherapy is appropriate outside of a clinical trial.

Original languageEnglish (US)
Pages (from-to)1043-1049
Number of pages7
JournalJournal of Thoracic Oncology
Volume8
Issue number8
DOIs
StatePublished - Aug 2013

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Induction Chemotherapy
Small Cell Lung Carcinoma
Platinum
Radiotherapy
Confidence Intervals
Radiotherapy Dosage
Drug Therapy
Survival
Disease-Free Survival
Survival Rate
Leukemia
Logistic Models
Neoplasms
Esophagitis
Proportional Hazards Models
Multivariate Analysis
Clinical Trials
Population

Keywords

  • Chemoradiotherapy
  • Dosage-escalated radiotherapy
  • Limited-stage small-cell lung cancer

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

A pooled analysis of limited-stage small-cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy : CALGB 30904. / Salama, Joseph K.; Hodgson, Lydia; Pang, Herbert; Urbanic, James J.; Blackstock, A. William; Schild, Steven E.; Crawford, Jeffrey; Bogart, Jeffrey A.; Vokes, Everett E.

In: Journal of Thoracic Oncology, Vol. 8, No. 8, 08.2013, p. 1043-1049.

Research output: Contribution to journalArticle

Salama, Joseph K. ; Hodgson, Lydia ; Pang, Herbert ; Urbanic, James J. ; Blackstock, A. William ; Schild, Steven E. ; Crawford, Jeffrey ; Bogart, Jeffrey A. ; Vokes, Everett E. / A pooled analysis of limited-stage small-cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy : CALGB 30904. In: Journal of Thoracic Oncology. 2013 ; Vol. 8, No. 8. pp. 1043-1049.
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abstract = "INTRODUCTION: Standard therapy for limited-stage small-cell lung cancer (L-SCLC) is concurrent chemotherapy and radiotherapy (RT) followed by prophylactic cranial radiotherapy. Although many consider the standard RT regimen to be 45 Gy in 1.5 Gy twice-daily fractions, this has failed to gain widespread acceptance. We pooled data of patients assigned to receive daily RT of 70 Gy from three, consecutive prospective Cancer and Leukemia Group B L-SCLC cancer trials and report the results here. METHODS: All patients from consecutive Cancer and Leukemia Group B L-SCLC trials (39808, 30002, and 30206) using high-dosage daily RT with concurrent chemotherapy were included, and analyzed for toxicity, disease control, and survival. Overall survival (OS) and progression-free survival (PFS) were modeled using Cox proportional hazards models. Prognostic variables for OS-rate and PFS-rate were assessed using logistic regression model. RESULTS: Two hundred patients were included. The median follow-up was 78 months. Grade 3 or greater esophagitis was 23{\%}. The median OS for pooled population was 19.9 months (95{\%} confidence interval [CI]: 16.7-22.3), and 5-year OS rate was 20{\%} (95{\%} CI: 16-27{\%}). The 2-year PFS was 26{\%} (95{\%} CI: 21-32{\%}). Multivariate analysis found younger age (p = 0.02; hazard ratio [HR]: 1.023; 95{\%} CI: 21-32), and female sex (p = 0.02; HR:0.69; 95{\%} CI: 0.50-0.94) independently associated with improved overall survival. CONCLUSION: Two-Gy daily RT to a total dosage of 70 Gy was well tolerated with similar survival to 45 Gy (1.5 Gy twice-daily). This experience may aid practitioners decide whether high-dosage daily RT with platinum-based chemotherapy is appropriate outside of a clinical trial.",
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T1 - A pooled analysis of limited-stage small-cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy

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AU - Salama, Joseph K.

AU - Hodgson, Lydia

AU - Pang, Herbert

AU - Urbanic, James J.

AU - Blackstock, A. William

AU - Schild, Steven E.

AU - Crawford, Jeffrey

AU - Bogart, Jeffrey A.

AU - Vokes, Everett E.

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AB - INTRODUCTION: Standard therapy for limited-stage small-cell lung cancer (L-SCLC) is concurrent chemotherapy and radiotherapy (RT) followed by prophylactic cranial radiotherapy. Although many consider the standard RT regimen to be 45 Gy in 1.5 Gy twice-daily fractions, this has failed to gain widespread acceptance. We pooled data of patients assigned to receive daily RT of 70 Gy from three, consecutive prospective Cancer and Leukemia Group B L-SCLC cancer trials and report the results here. METHODS: All patients from consecutive Cancer and Leukemia Group B L-SCLC trials (39808, 30002, and 30206) using high-dosage daily RT with concurrent chemotherapy were included, and analyzed for toxicity, disease control, and survival. Overall survival (OS) and progression-free survival (PFS) were modeled using Cox proportional hazards models. Prognostic variables for OS-rate and PFS-rate were assessed using logistic regression model. RESULTS: Two hundred patients were included. The median follow-up was 78 months. Grade 3 or greater esophagitis was 23%. The median OS for pooled population was 19.9 months (95% confidence interval [CI]: 16.7-22.3), and 5-year OS rate was 20% (95% CI: 16-27%). The 2-year PFS was 26% (95% CI: 21-32%). Multivariate analysis found younger age (p = 0.02; hazard ratio [HR]: 1.023; 95% CI: 21-32), and female sex (p = 0.02; HR:0.69; 95% CI: 0.50-0.94) independently associated with improved overall survival. CONCLUSION: Two-Gy daily RT to a total dosage of 70 Gy was well tolerated with similar survival to 45 Gy (1.5 Gy twice-daily). This experience may aid practitioners decide whether high-dosage daily RT with platinum-based chemotherapy is appropriate outside of a clinical trial.

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