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SCLC extensive disease--treatment guidance by extent or/and biology of response?

Eckert F, Müller AC - Radiat Oncol (2008)

Bottom Line: In extensive disease of small cell lung cancer a doubling of the one-year-survival rate was reported in August 2007 by prophylactic cranial irradiation applied to patients who experienced any response to initial chemotherapy.Considering both, a possible interpretation of these data could be a survival benefit of local control by simultaneous thoracic radiochemotherapy in the case of improved distant control due to chemotherapy and prophylactic cranial irradiation.Furthermore the question arises whether the tumor biology indicated by the response to chemotherapy should be integrated in the present classification.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiooncology, Eberhard-Karls-University Tübingen, Germany. franziska.eckert@med.uni-tuebingen.de

ABSTRACT
In extensive disease of small cell lung cancer a doubling of the one-year-survival rate was reported in August 2007 by prophylactic cranial irradiation applied to patients who experienced any response to initial chemotherapy. We discuss the treatment concept of extensive disease in the face of the latest results and older studies with additional thoracic irradiation in this subgroup. A randomized trial with prophylactic cranial irradiation published in 1999 demonstrated an improvement of 5-year-overall-survival for complete responders (at least at distant levels) receiving additional thoracic radiochemotherapy compared to chemotherapy alone (9.1% vs. 3.7%). But, these results were almost neglected and thoracic radiotherapy was not further investigated for good responders of extensive disease. However, in the light of current advances by prophylactic cranial irradiation these findings are noteworthy on all accounts. Considering both, a possible interpretation of these data could be a survival benefit of local control by simultaneous thoracic radiochemotherapy in the case of improved distant control due to chemotherapy and prophylactic cranial irradiation. Furthermore the question arises whether the tumor biology indicated by the response to chemotherapy should be integrated in the present classification.

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Suggested treatment strategy for ED-SCLC. Based on recent and older, hardly considered data [2,5] there could be three different treatment strategies according to initial response to chemotherapy: Chemotherapy plus TRT (simultaneously with the 4th cycle) and PCI for good responders achieving complete remission at least at distant levels; chemotherapy and PCI for patients having any response; second line chemotherapy or best supportive care for stable or progressive disease.
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Figure 1: Suggested treatment strategy for ED-SCLC. Based on recent and older, hardly considered data [2,5] there could be three different treatment strategies according to initial response to chemotherapy: Chemotherapy plus TRT (simultaneously with the 4th cycle) and PCI for good responders achieving complete remission at least at distant levels; chemotherapy and PCI for patients having any response; second line chemotherapy or best supportive care for stable or progressive disease.

Mentions: Taken together the results of Slotman et al. and Jeremic et al. lead to the question whether the treatment for extensive disease SCLC should be reconsidered. There could be three different treatment strategies according to initial response to chemotherapy: Chemotherapy plus TRT (simultaneously with the 4th cycle) and PCI for good responders achieving complete remission at least at distant levels; chemotherapy and PCI for patients having less than complete response; second line chemotherapy or best supportive care for stable or progressive disease (Figure 1). If this therapy was established, the difference in treatment of limited and extensive disease in complete responders would diminish. The best estimated 5-year-overall-survival for the described schedule could exceed 20% for limited and reach almost 10% for extensive disease [4,5,10]. Based on the available data the question arises, whether the present classification should be supplemented by biology of response. Surely, randomized trials are essential to evaluate this proposed procedure. Furthermore, the significance of potential confounders like treatment of asymptomatic brain metastasis by PCI, prognostic relevance of metastatic pattern within the heterogeneous group of ED-SCLC and subsequent second line treatment could be analyzed.


SCLC extensive disease--treatment guidance by extent or/and biology of response?

Eckert F, Müller AC - Radiat Oncol (2008)

Suggested treatment strategy for ED-SCLC. Based on recent and older, hardly considered data [2,5] there could be three different treatment strategies according to initial response to chemotherapy: Chemotherapy plus TRT (simultaneously with the 4th cycle) and PCI for good responders achieving complete remission at least at distant levels; chemotherapy and PCI for patients having any response; second line chemotherapy or best supportive care for stable or progressive disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2570671&req=5

Figure 1: Suggested treatment strategy for ED-SCLC. Based on recent and older, hardly considered data [2,5] there could be three different treatment strategies according to initial response to chemotherapy: Chemotherapy plus TRT (simultaneously with the 4th cycle) and PCI for good responders achieving complete remission at least at distant levels; chemotherapy and PCI for patients having any response; second line chemotherapy or best supportive care for stable or progressive disease.
Mentions: Taken together the results of Slotman et al. and Jeremic et al. lead to the question whether the treatment for extensive disease SCLC should be reconsidered. There could be three different treatment strategies according to initial response to chemotherapy: Chemotherapy plus TRT (simultaneously with the 4th cycle) and PCI for good responders achieving complete remission at least at distant levels; chemotherapy and PCI for patients having less than complete response; second line chemotherapy or best supportive care for stable or progressive disease (Figure 1). If this therapy was established, the difference in treatment of limited and extensive disease in complete responders would diminish. The best estimated 5-year-overall-survival for the described schedule could exceed 20% for limited and reach almost 10% for extensive disease [4,5,10]. Based on the available data the question arises, whether the present classification should be supplemented by biology of response. Surely, randomized trials are essential to evaluate this proposed procedure. Furthermore, the significance of potential confounders like treatment of asymptomatic brain metastasis by PCI, prognostic relevance of metastatic pattern within the heterogeneous group of ED-SCLC and subsequent second line treatment could be analyzed.

Bottom Line: In extensive disease of small cell lung cancer a doubling of the one-year-survival rate was reported in August 2007 by prophylactic cranial irradiation applied to patients who experienced any response to initial chemotherapy.Considering both, a possible interpretation of these data could be a survival benefit of local control by simultaneous thoracic radiochemotherapy in the case of improved distant control due to chemotherapy and prophylactic cranial irradiation.Furthermore the question arises whether the tumor biology indicated by the response to chemotherapy should be integrated in the present classification.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiooncology, Eberhard-Karls-University Tübingen, Germany. franziska.eckert@med.uni-tuebingen.de

ABSTRACT
In extensive disease of small cell lung cancer a doubling of the one-year-survival rate was reported in August 2007 by prophylactic cranial irradiation applied to patients who experienced any response to initial chemotherapy. We discuss the treatment concept of extensive disease in the face of the latest results and older studies with additional thoracic irradiation in this subgroup. A randomized trial with prophylactic cranial irradiation published in 1999 demonstrated an improvement of 5-year-overall-survival for complete responders (at least at distant levels) receiving additional thoracic radiochemotherapy compared to chemotherapy alone (9.1% vs. 3.7%). But, these results were almost neglected and thoracic radiotherapy was not further investigated for good responders of extensive disease. However, in the light of current advances by prophylactic cranial irradiation these findings are noteworthy on all accounts. Considering both, a possible interpretation of these data could be a survival benefit of local control by simultaneous thoracic radiochemotherapy in the case of improved distant control due to chemotherapy and prophylactic cranial irradiation. Furthermore the question arises whether the tumor biology indicated by the response to chemotherapy should be integrated in the present classification.

Show MeSH
Related in: MedlinePlus