Increased Biological Effective Dose of Radiation Correlates with Prolonged Survival of Patients with Limited-Stage Small Cell Lung Cancer: A Systematic Review

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2016 May 27

PMID 27227819

Citations 9

Authors

Lucheng Zhu

Shirong Zhang

Xiao Xu

Bing Wang

Kan Wu

Qinghua Deng

Bing Xia

Shenglin Ma

Affiliations

Soon will be listed here.

Abstract

Objective: Thoracic radiotherapy (TRT) is a critical component of the treatment of limited-stage small cell lung cancer (LS-SCLC). However, the optimal radiation dose/fractionation remains elusive. This study reviewed current evidence and explored the dose-response relationship in patients with LS-SCLC who were treated with radiochemotherapy.

Materials And Methods: A quantitative analysis was performed through a systematic search of PubMed, Web of Science, and the Cochrane Library. The correlations between the biological effective dose (BED) and median overall survival (mOS), median progression-free survival (mPFS), 1-, 3-, and 5-year overall survival (OS) as well as local relapse (LR) were evaluated.

Results: In all, 2389 patients in 19 trials were included in this study. Among these 19 trials, seven were conducted in Europe, eight were conducted in Asia and four were conducted in the United States. The 19 trials that were included consisted of 29 arms with 24 concurrent and 5 sequential TRT arms. For all included studies, the results showed that a higher BED prolonged the mOS (R2 = 0.198, p<0.001) and the mPFS (R2 = 0.045, p<0.001). The results also showed that increased BED improved the 1-, 3-, and 5-year OS. A 10-Gy increment added a 6.3%, a 5.1% and a 3.7% benefit for the 1-, 3-, and 5-year OS, respectively. Additionally, BED was negatively correlated with LR (R2 = 0.09, p<0.001). A subgroup analysis of concurrent TRT showed that a high BED prolonged the mOS (p<0.001) and the mPFS (p<0.001), improved the 1-, 3-, and 5-year OS (p<0.001) and decreased the rate of LR (p<0.001).

Conclusion: This study showed that an increased BED was associated with improved OS, PFS and decreased LR in patients with LS-SCLC who were treated with combined chemoradiotherapy, which indicates that the strategy of radiation dose escalation over a limited time frame is worth exploring in a prospective clinical trial.

Citing Articles

The Dose/Fractionation Debate in Limited-Stage Small Cell Lung Cancer.

Du K, Liao X, Kishi K Cancers (Basel). 2024; 16(10).

PMID: 38791986 PMC: 11119808. DOI: 10.3390/cancers16101908.

Treatment patterns and outcomes among patients with small-cell lung cancer (SCLC) in Europe: a retrospective cohort study.

Blackhall F, Girard N, Livartowski A, McDonald L, Roset M, Lara N BMJ Open. 2023; 13(2):e052556.

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Cho Y, Lee J, Lee I, Kim J, Baek J, Jung D Sci Rep. 2021; 11(1):7435.

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High Biologically Effective Dose Radiotherapy for Brain Metastases May Improve Survival and Decrease Risk for Local Relapse Among Patients With Small-Cell Lung Cancer: A Propensity-Matching Analysis.

Zhuang Q, Li J, Lin F, Lin X, -Lin H, -Wang Y Cancer Control. 2020; 27(2):1073274820936287.

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Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline.

Simone 2nd C, Bogart J, Cabrera A, Daly M, DeNunzio N, Detterbeck F Pract Radiat Oncol. 2020; 10(3):158-173.

PMID: 32222430 PMC: 10915746. DOI: 10.1016/j.prro.2020.02.009.

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