Cargando…
A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis
SIMPLE SUMMARY: The optimal thoracic radiotherapy schedule for limited-stage small cell lung cancer (LS-SCLC) patients remains controversial. We conducted a propensity score adjusted analysis of LS-SCLC patients treated at our institutions with 40Gy/15 fractions versus 45Gy/30 twice daily. After ove...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229231/ https://www.ncbi.nlm.nih.gov/pubmed/34207857 http://dx.doi.org/10.3390/cancers13122895 |
_version_ | 1783712928762953728 |
---|---|
author | Yan, Michael Sigurdson, Samantha Greifer, Noah Kennedy, Thomas A. C. Toh, Tzen S. Lindsay, Patricia E. Weiss, Jessica Hueniken, Katrina Yeung, Christy Sugumar, Vijithan Sun, Alexander Bezjak, Andrea Cho, B. C. John Raman, Srinivas Hope, Andrew J. Giuliani, Meredith E. Stuart, Elizabeth A. Owen, Timothy Ashworth, Allison Robinson, Andrew de Moraes, Fabio Ynoe Liu, Geoffrey Lok, Benjamin H. |
author_facet | Yan, Michael Sigurdson, Samantha Greifer, Noah Kennedy, Thomas A. C. Toh, Tzen S. Lindsay, Patricia E. Weiss, Jessica Hueniken, Katrina Yeung, Christy Sugumar, Vijithan Sun, Alexander Bezjak, Andrea Cho, B. C. John Raman, Srinivas Hope, Andrew J. Giuliani, Meredith E. Stuart, Elizabeth A. Owen, Timothy Ashworth, Allison Robinson, Andrew de Moraes, Fabio Ynoe Liu, Geoffrey Lok, Benjamin H. |
author_sort | Yan, Michael |
collection | PubMed |
description | SIMPLE SUMMARY: The optimal thoracic radiotherapy schedule for limited-stage small cell lung cancer (LS-SCLC) patients remains controversial. We conducted a propensity score adjusted analysis of LS-SCLC patients treated at our institutions with 40Gy/15 fractions versus 45Gy/30 twice daily. After overlap weighting for clinical and treatment variables and attaining good balance, we did not find a significant difference in overall survival, locoregional recurrence risk, thoracic response, or ≥grade 3 toxicity. Moderate hypofractionation, with its similar outcomes and logistical advantages, may present a reasonable alternative to twice daily radiotherapy. ABSTRACT: Despite evidence for the superiority of twice-daily (BID) radiotherapy schedules, their utilization in practice remains logistically challenging. Hypofractionation (HFRT) is a commonly implemented alternative. We aim to compare the outcomes and toxicities in limited-stage small-cell lung cancer (LS-SCLC) patients treated with hypofractionated versus BID schedules. A bi-institutional retrospective cohort review was conducted of LS-SCLC patients treated with BID (45 Gy/30 fractions) or HFRT (40 Gy/15 fractions) schedules from 2007 to 2019. Overlap weighting using propensity scores was performed to balance observed covariates between the two radiotherapy schedule groups. Effect estimates of radiotherapy schedule on overall survival (OS), locoregional recurrence (LRR) risk, thoracic response, any ≥grade 3 (including lung, and esophageal) toxicity were determined using multivariable regression modelling. A total of 173 patients were included in the overlap-weighted analysis, with 110 patients having received BID treatment, and 63 treated by HFRT. The median follow-up was 20.4 months. Multivariable regression modelling did not reveal any significant differences in OS (hazard ratio [HR] 1.67, p = 0.38), LRR risk (HR 1.48, p = 0.38), thoracic response (odds ratio [OR] 0.23, p = 0.21), any ≥grade 3+ toxicity (OR 1.67, p = 0.33), ≥grade 3 pneumonitis (OR 1.14, p = 0.84), or ≥grade 3 esophagitis (OR 1.41, p = 0.62). HFRT, in comparison to BID radiotherapy schedules, does not appear to result in significantly different survival, locoregional control, or toxicity outcomes. |
format | Online Article Text |
id | pubmed-8229231 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-82292312021-06-26 A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis Yan, Michael Sigurdson, Samantha Greifer, Noah Kennedy, Thomas A. C. Toh, Tzen S. Lindsay, Patricia E. Weiss, Jessica Hueniken, Katrina Yeung, Christy Sugumar, Vijithan Sun, Alexander Bezjak, Andrea Cho, B. C. John Raman, Srinivas Hope, Andrew J. Giuliani, Meredith E. Stuart, Elizabeth A. Owen, Timothy Ashworth, Allison Robinson, Andrew de Moraes, Fabio Ynoe Liu, Geoffrey Lok, Benjamin H. Cancers (Basel) Article SIMPLE SUMMARY: The optimal thoracic radiotherapy schedule for limited-stage small cell lung cancer (LS-SCLC) patients remains controversial. We conducted a propensity score adjusted analysis of LS-SCLC patients treated at our institutions with 40Gy/15 fractions versus 45Gy/30 twice daily. After overlap weighting for clinical and treatment variables and attaining good balance, we did not find a significant difference in overall survival, locoregional recurrence risk, thoracic response, or ≥grade 3 toxicity. Moderate hypofractionation, with its similar outcomes and logistical advantages, may present a reasonable alternative to twice daily radiotherapy. ABSTRACT: Despite evidence for the superiority of twice-daily (BID) radiotherapy schedules, their utilization in practice remains logistically challenging. Hypofractionation (HFRT) is a commonly implemented alternative. We aim to compare the outcomes and toxicities in limited-stage small-cell lung cancer (LS-SCLC) patients treated with hypofractionated versus BID schedules. A bi-institutional retrospective cohort review was conducted of LS-SCLC patients treated with BID (45 Gy/30 fractions) or HFRT (40 Gy/15 fractions) schedules from 2007 to 2019. Overlap weighting using propensity scores was performed to balance observed covariates between the two radiotherapy schedule groups. Effect estimates of radiotherapy schedule on overall survival (OS), locoregional recurrence (LRR) risk, thoracic response, any ≥grade 3 (including lung, and esophageal) toxicity were determined using multivariable regression modelling. A total of 173 patients were included in the overlap-weighted analysis, with 110 patients having received BID treatment, and 63 treated by HFRT. The median follow-up was 20.4 months. Multivariable regression modelling did not reveal any significant differences in OS (hazard ratio [HR] 1.67, p = 0.38), LRR risk (HR 1.48, p = 0.38), thoracic response (odds ratio [OR] 0.23, p = 0.21), any ≥grade 3+ toxicity (OR 1.67, p = 0.33), ≥grade 3 pneumonitis (OR 1.14, p = 0.84), or ≥grade 3 esophagitis (OR 1.41, p = 0.62). HFRT, in comparison to BID radiotherapy schedules, does not appear to result in significantly different survival, locoregional control, or toxicity outcomes. MDPI 2021-06-09 /pmc/articles/PMC8229231/ /pubmed/34207857 http://dx.doi.org/10.3390/cancers13122895 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Yan, Michael Sigurdson, Samantha Greifer, Noah Kennedy, Thomas A. C. Toh, Tzen S. Lindsay, Patricia E. Weiss, Jessica Hueniken, Katrina Yeung, Christy Sugumar, Vijithan Sun, Alexander Bezjak, Andrea Cho, B. C. John Raman, Srinivas Hope, Andrew J. Giuliani, Meredith E. Stuart, Elizabeth A. Owen, Timothy Ashworth, Allison Robinson, Andrew de Moraes, Fabio Ynoe Liu, Geoffrey Lok, Benjamin H. A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis |
title | A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis |
title_full | A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis |
title_fullStr | A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis |
title_full_unstemmed | A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis |
title_short | A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis |
title_sort | comparison of hypofractionated and twice-daily thoracic irradiation in limited-stage small-cell lung cancer: an overlap-weighted analysis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229231/ https://www.ncbi.nlm.nih.gov/pubmed/34207857 http://dx.doi.org/10.3390/cancers13122895 |
work_keys_str_mv | AT yanmichael acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT sigurdsonsamantha acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT greifernoah acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT kennedythomasac acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT tohtzens acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT lindsaypatriciae acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT weissjessica acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT huenikenkatrina acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT yeungchristy acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT sugumarvijithan acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT sunalexander acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT bezjakandrea acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT chobcjohn acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT ramansrinivas acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT hopeandrewj acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT giulianimeredithe acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT stuartelizabetha acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT owentimothy acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT ashworthallison acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT robinsonandrew acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT demoraesfabioynoe acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT liugeoffrey acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT lokbenjaminh acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT yanmichael comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT sigurdsonsamantha comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT greifernoah comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT kennedythomasac comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT tohtzens comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT lindsaypatriciae comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT weissjessica comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT huenikenkatrina comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT yeungchristy comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT sugumarvijithan comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT sunalexander comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT bezjakandrea comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT chobcjohn comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT ramansrinivas comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT hopeandrewj comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT giulianimeredithe comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT stuartelizabetha comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT owentimothy comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT ashworthallison comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT robinsonandrew comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT demoraesfabioynoe comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT liugeoffrey comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis AT lokbenjaminh comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis |