Accelerated Hypofractionated Radiotherapy and Concurrent Etoposide/Cisplatin in Patients with Limited-Disease SCLC (LD-SCLC)

Background: The optimal TRT dose/fraction for LD-SCLC remains debatable, and due to increasing number of population in Egypt and number of patients as well, so reducing the duration of radiation therapy is favored. This study was conducted using etoposide and cisplatin (EP) concurrently with accelerated hypofractionated TRT to evaluate the response and toxicity of this protocol in the treatment of patients with limited-disease small cell lung cancer (LD-SCLC). Patients and Methods: Thirty patients with previously untreated LD-SCLC were enrolled into this study between June 2012 and February 2015. All patients received etoposide 100 mg/m2 days 1 to 3 and cisplatin 25 mg/m2 days 1 to 3 with start of accelerated hypofractionated thoracic radiation therapy on first day of the second cycle of chemotherapy of 55 Gy, 2.5 Gy/fraction over 30 days. Chemotherapy was given 4 - 6 cycles. Prophylactic cranial irradiation 25 Gy/10 fractions were given for patients who achieved complete remission. Results: The median age was 60 years;28 patients (93%) were men. ECOG PS was 0 in 5 (17%) patients and 1 in 12 (40%) patients. Four (13%) patients achieved a complete response (CR), 17 (57%) patients achieved a partial response (PR), while 7 patients (23%) had progressive disease (PD), and the ORR was 90%. The median survival time was 26.4 months. The median PFS was 16.7 months. Among the hematologic toxicities neutropenia was the most prevalent toxicity and it was evident as grade 3 - 4 in 12 (40%) patients. Grade 3 - 4 Asthenia was the most prevalent nonhematological toxicity, in 12 (40%) patients;esophagitis occurred in 7 (23%) patients. No treatment-related deaths (due to sepsis or bleeding) were reported in the study. Conclusion: Using etoposide and cisplatin concurrently with accelerated hypofractionated thoracic radiation therapy for the treatment of patients with LD-SCLC showed an encouraging outcome and acceptable toxicity and warrants further research.