Headline: Dose-escalated twice-daily radiation may improve survival for limited-stage small cell lung cancer (LS-SCLC).
The Study: Conventionally fractionated radiation has yet to best 45 Gy in 30 BID fractions for limited stage SCLC. But we’ve seen some trials of hypofractionation and even BID dose-escalation nudge the needle on treatment outcomes. Here’s a Chinese phase 3 trial that randomized 224 patients receiving chemoradiation for LS-SCLC with platinum-based chemo + etoposide to either standard 45 Gy or dose-escalated 54 Gy via simultaneous integrated boost (SIB) to gross disease all in 30 twice-daily fractions over three weeks via VMAT. The primary endpoint of overall survival was significantly improved from a median of 43 months after standard treatment to 62 months after dose escalation. What's more, median progression-free survival was nearly doubled from 17 to 31 months. There was no significant difference in rates of serious adverse events: 14% (n=16) after standard versus 8% (n=9) after dose-escalated radiation.
TBL: Adding an SIB to 54 Gy to gross disease during definitive twice-daily chemoradiation via VMAT for LS-SCLC is safe and appears to dramatically prolong survival. So dramatically, we’re very interested in the final manuscript and discussion on this one. | Yu, ASTRO 2023
The Study: Conventionally fractionated radiation has yet to best 45 Gy in 30 BID fractions for limited stage SCLC. But we’ve seen some trials of hypofractionation and even BID dose-escalation nudge the needle on treatment outcomes. Here’s a Chinese phase 3 trial that randomized 224 patients receiving chemoradiation for LS-SCLC with platinum-based chemo + etoposide to either standard 45 Gy or dose-escalated 54 Gy via simultaneous integrated boost (SIB) to gross disease all in 30 twice-daily fractions over three weeks via VMAT. The primary endpoint of overall survival was significantly improved from a median of 43 months after standard treatment to 62 months after dose escalation. What's more, median progression-free survival was nearly doubled from 17 to 31 months. There was no significant difference in rates of serious adverse events: 14% (n=16) after standard versus 8% (n=9) after dose-escalated radiation.
TBL: Adding an SIB to 54 Gy to gross disease during definitive twice-daily chemoradiation via VMAT for LS-SCLC is safe and appears to dramatically prolong survival. So dramatically, we’re very interested in the final manuscript and discussion on this one. | Yu, ASTRO 2023