“Proton-beam therapy (PBT) was found to be safe for patients with limited-stage (LS) small-cell lung cancer (SCLC) in the first prospective registry study of the therapy, with only a small number of high-grade toxicities.
” ‘Radiation therapy is essential for the management of limited-stage SCLC,’ wrote study authors led by Jean-Claude M. Rwigema, MD, of the Hospital of the University of Pennsylvania in Philadelphia. ‘When it is given with concurrent chemotherapy, radiation therapy can result in substantial toxicities.’ PBT can reduce the exposure to nearby organs at risk in non–small-cell lung cancer, and is under substantial investigation in that setting; before the new study, though, only a six-patient case series had examined its use in SCLC.”
“Chemoradiotherapy (CRT) is associated with survival benefit over chemotherapy (CT) alone for elderly patients with limited-stage small-cell lung cancer, according to a study published online Oct. 19 in the Journal of Clinical Oncology.
“Christopher D. Corso, M.D., Ph.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues examined outcomes for elderly patients (≥70 years) treated with CT versus CRT. Data were included for 8,637 patients with limited-stage small-cell lung cancer in the National Cancer Data Base between 2003 and 2011.
“The researchers found that 43.7 and 56.3 percent of the patients received CT and CRT, respectively. CRT receipt was less likely with increasing age, clinical stage III disease, female sex, and the presence of medical comorbidities (all P < 0.01). Compared with CT, CRT use correlated with increased overall survival on univariate and multivariate analysis (median overall survival, 15.6 versus 9.3 months). Survival benefit associated with CRT was confirmed in a propensity score-matched cohort of 6,856 patients (hazard ratio, 0.52; P < 0.001). In subset analysis, patients who were alive at four months after diagnosis had a survival benefit with concurrent versus sequential CRT (median overall survival, 17.0 versus 15.4 months; log-rank P = 0.01).”
Accurately ‘staging’ small cell lung cancer (SCLC), that is, determining its extent and spread in a patient, is crucial in choosing treatment. One year after treatment guidelines began recommending positron emission tomography – computed tomography (PET-CT) instead of bone scans for the initial evaluation of all newly diagnosed SCLC patients, researchers confirmed that the new staging method improved outcomes. A study of SCLC patients diagnosed with limited-stage disease (ie, cancer that is confined to only one lung or its immediately surrounding tissue) showed that those who had received PET-CT staging before their treatment had higher 3-year survival rates (47% vs 19%) than those who did not.