"Twice-Daily versus Once-Daily Thoracic Radiotherapy in Limited Small-Cell Lung Cancer Treated with Cisplatin and Etoposide". New England Journal of Medicine. 1999. 340(4):265-271. PubMed
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Design 5 Population 5.1 Inclusion Criteria 5.2 Exclusion Criteria 5.3 Baseline Characteristics 6 Interventions 7 Outcomes 7.1 Primary Outcome 7.2 Secondary Outcomes 8 Funding 9 Further Reading
In patients with limited small-cell lung cancer, does twice-daily thoracic radiotherapy improve survival compared with once-daily thoracic radiotherapy when both are combined with cisplatin and etoposide?
In patients with limited small-cell lung cancer, twice-daily thoracic radiotherapy significantly improved survival compared with once-daily therapy when combined with cisplatin and etoposide, but increased the risk of grade 3 esophagitis.
Twice-daily accelerated thoracic radiotherapy, when combined with cisplatin and etoposide, offers a survival advantage over once-daily radiotherapy in limited small-cell lung cancer, with a 10% higher 5-year survival rate.
- Multicenter, randomized, controlled trial - N=417 patients with limited small-cell lung cancer - Once-daily thoracic radiotherapy (n=206) - Twice-daily thoracic radiotherapy (n=211) - Setting: Multiple institutions - Enrollment: May 1989 to July 1992 - Mean follow-up: Almost 8 years - Analysis: Intention-to-treat - Primary outcome: Overall survival
Inclusion Criteria - Small-cell lung cancer clinically confined to one hemithorax (limited) - Adequate organ function and performance status
Exclusion Criteria - Pleural effusions visible on chest films, symptomatic cardiac disease, previous chemotherapy or radiotherapy, prior cancer
Baseline Characteristics - Median age: 63 years (once-daily), 61 years (twice-daily) - Sex: 40% female
- Four cycles of chemotherapy with cisplatin (60 mg/m² on day 1) and etoposide (120 mg/m² on days 1-3) every 21 days - Thoracic radiotherapy 45 Gy total dose, delivered as - Once-daily (1.8 Gy per day) over five weeks - Twice-daily (1.5 Gy per treatment) over three weeks - Prophylactic cranial irradiation offered to patients with complete response
Primary Outcome - Median survival: 19 months for once-daily, 23 months for twice-daily - 2-year survival rate: 41% for once-daily, 47% for twice-daily - 5-year survival rate: 16% for once-daily, 26% for twice-daily
- Grade 3 esophagitis: 11% for once-daily, 27% for twice-daily
- Public Health Service grants from the National Cancer Institute, National Institutes of Health, and Department of Health and Human Services
- Full text article available on the New England Journal of Medicine website