Once-daily Radiotherapy Not Superior to Twice-daily in SCLC

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Once-daily radiotherapy is not superior to twice-daily treatment for patients with small-cell lung cancer receiving concurrent chemoradiotherapy.
Once-daily radiotherapy is not superior to twice-daily treatment for patients with small-cell lung cancer receiving concurrent chemoradiotherapy.

Once-daily radiotherapy is not superior to twice-daily treatment for patients with small-cell lung cancer (SCLC) receiving concurrent chemoradiotherapy, according to a study published in The Lancet Oncology.1

SCLC, which is highly aggressive even from an early stage and carries a poor prognosis, tends to respond to concurrent chemoradiotherapy. Although radiation is typically administered in 2 daily doses, researchers hypothesized that once-daily higher-dose radiotherapy would improve outcomes in this setting.

For the randomized phase 3 CONVERT trial (ClinicalTrials.gov Identifier: NCT00433563), researchers enrolled 547 patients with SCLC to receive radiotherapy 1.5 Gy twice-daily for 30 fractions over 19 days or 2 Gy once-daily for 33 fractions.

Patients in both groups received concurrent cisplatin-etoposide for 4 or 6 cycles.

Of 274 and 273 patients assigned to receive twice-daily and once-daily chemoradiotherapy, respectively, 249 and 240 underwent concurrent treatment. Almost all initially assigned patients were, however, included in the survival analysis.

Patient characteristics were similar in the 2 groups: in the twice-daily group and the once-daily group, respectively, median age was 62 and 63 years, 96% and 97% of patients were Caucasian, and 98% and 99% of patients were former or current smokers.

Median follow-up was 45 months. In the twice-daily group and once-daily group, median overall survival was 30 months vs 25 months, respectively; 2-year overall survival rates were 56% and 51%, respectively.

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Toxicity was similar in both groups, though grade 4 neutropenia was more common in the twice-daily group. There were 3 treatment-related deaths in the twice-daily group and 8 in the once-daily group.

The authors concluded that “from a pragmatic perspective, once-daily radiotherapy could be considered when delivery of twice-daily radiotherapy is impossible because of departmental logistics or patient choice.”

Reference

  1. Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol. 2017 Jun 19. doi: 10.1016/S1470-2045(17)30318-2 [Epub ahead of print]

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