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Is there a place for low-dose chest and prophylactic brain irradiation in limited-disease small cell lung cancer

Vees, Hansjorg
Hugli, Anne
Balmer Majno, Sabine
Published in Medical Oncology. 2009, vol. 26, no. 3, p. 298-302
Abstract The aim of the study is to evaluate the outcome of low-dose bifractionated up-front radiotherapy (RT) followed by chemotherapy (CHT) in limited-disease small cell lung cancer (LD-SCLC). From December 1999 to February 2002, 20 LD-SCLC consecutive patients were treated by initial involved-field thoracic irradiation of 2 Gy twice daily to a total dose of 20 Gy, and concomitant prophylactic cranial irradiation (PCI) of 1.8 Gy twice daily to a total dose of 18 Gy followed 3 days later by 4-6 cycles of CHT with cisplatin and etoposide. Median follow-up was 66 months (52-77). There were no Grade 3-4 esophagitis or pneumonitis. Response rate was 90%, 45% of the patients showing a complete and 45% a partial response. Median time to first event was 13 months. Forty percent showed local infield recurrence, while 55% presented distant metastasis, 4 of them in the brain. Median survival time was 28 months. The Kaplan-Meier 1-, 3-, and 5-years survival rates were 95%, 35%, and 21%, respectively. Salvage RT was applied for local recurrence in 7 patients and for distant metastasis in 7 patients. The rate of brain recurrence with up-front low-dose PCI is favorable and should be further evaluated. Although the response and survival rates are promising, the high number of local recurrences indicates that the irradiation dose is insufficient for patients whose disease can be encompassed within a radical radiation portal.
Keywords AdultAgedAntineoplastic Combined Chemotherapy Protocols/therapeutic useBrain Neoplasms/*prevention & control/radiotherapy/*secondaryCombined Modality TherapyFemaleHumansKaplan-Meier EstimateLung Neoplasms/drug therapy/*radiotherapyMaleMiddle AgedRadiotherapy/adverse effects/methodsSmall Cell Lung Carcinoma/drug therapy/*radiotherapy
PMID: 19002616
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Research group La recherche translationnelle en oncologie (654)
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VEES, Hansjorg et al. Is there a place for low-dose chest and prophylactic brain irradiation in limited-disease small cell lung cancer. In: Medical Oncology, 2009, vol. 26, n° 3, p. 298-302. doi: 10.1007/s12032-008-9119-2 https://archive-ouverte.unige.ch/unige:20150

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Deposited on : 2012-04-23

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