Abstract
Object. This study evaluated the results of chemoradiotherapy and the effectiveness of accelerated hyperfractionated prophylactic cranial irradiation (AHF-PCI) of 24 Gy/16 fractions/1.6 weeks for limited-stage small cell lung cancer (SCLC).Methods and Materials. Of 149 patients with SCLC who underwent thoracic irradiation between 1985 and 2000, 29 patients were excluded from this analysis because of extended disease (25), surgery (3) and synchronous double cancer (1), and the reminding 120 cases were analyzed retrospectively. Chemotherapy was performed for all patients. Thoracic radiation therapy (TRT) dose ranged from 10.5 Gy to 70 Gy. Survival differences were evaluated using the log-rank test and comparisons were made between the case and control populations using χ2 analysis. Results. Patient ages ranged from 38 to 88 years, with a mean of 65 years. The female-to-male ratio was 106: 14. There were no significant differences in outcome by patient characteristics or chemotherapy regimens. The overall survival rates at 2, 3, 5 years were 33%, 21%, 18%, respectively. AHF-TRT with Cisplatin+Etoposide (PE) yielded better survival than any other chemotherapy regimen. Of 47 patients showing complete response after completion of AHF-TRT (45 Gy/30 fractions) combined with 4 courses of PE, 23 patients received AHF-PCI of 24 Gy/ 16 fractions. Initial failure in the brain was 8.7%(2/23) in patients with the PCI, but 41.6%(10/24) in those without PCI, which was significantly different (p=0.0096). Conclusions.In limited-stage SCLC, AHF-TRT with PE was considered to be an effective chemoradiotherapy regimen. Relatively low dose (24 Gy) AHF-PCI seemed to be effective in preventing brain metasatses.
