The primary endpoints were mean DCC and percent of circulating cells receiving ≥0.5 Gy. Radiation protection. Between June 2008 and December 2013, 143 patients confirmed by pathology or cytology with stage I–III SCLC at the Shandong Cancer Hospital & Institute were retrospectively analyzed. The two‐year OS rate was 43.3% and 48.8% for QD and BID therapy, respectively. Nearly 90% had objective responses. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. The median age was 55 (range, 35–74) and 58 years (range, 45 to 71) for patients receiving QD and BID therapy, respectively. 45 0 obj <> endobj did not detect a statistically significant difference in acute toxicities in LD‐SCLC patients treated with concurrent chemotherapy and QD versus BID RT.17, Thoracic radiation affects patient outcome by decreasing the tumor burden within the chest, resulting in enhanced local control and survival. There were no significant differences between the groups in the incidence of grade 2 or higher hematologic toxicity. The differences in chemotherapy cycle numbers at the time of RT (P = 0.244) were not statistically significant between the two groups. The two‐year OS rate was 43.3% for QD therapy, and 48.8% for BID therapy. All plans were designed and optimized for Varian Trilogy equipped with a Millennium multileaf collimator (MLC) with 120 leaves for 6‐ or 15‐MV photon beams. One study of interest is a phase III trial comparing a hypofractionated course of 60 Gy in 15 fractions over 3 weeks with conventional radiotherapy (60–66 Gy in 30–33 fractions over 6 weeks to 7 weeks) without concurrent chemotherapy for patients with stage II–III NSCLC and poor performance status (NCT01459497). Learn more. The average age was 56 years; the male/female ratio … Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Meaning Pain response rates were higher for high-dose, single ... (12 Gy for ≥4-cm lesions or 16 Gy for <4-cm lesions) or MFRT to 30 Gy in 10 fractions. One hundred and twenty‐one (85%) patients received etoposide and cisplatin; of the remainder, 12 (8%) received etoposide and carboplatin, and 10 (7%) each received irinotecan and cisplatin or irinotecan and carboplatin. Elective treatment of clinically uninvolved lymphatic regions was not carried out. Fractions of 1.2 Gy were administered twice daily with greater than or equal to 4 hours between fractions. In the BID group, the prescribed dose was 45 Gy in 30 fractions at 1.5 Gy BID to the PTV. Of note, multiple studies have confirmed the equivalence of various dose fractionation schemes for whole‐brain radiotherapy, including 5 fractions of 4 Gy, 10 fractions of 3 Gy, 15 fractions of 2.5 Gy, and 20 fractions of 2 Gy without statistically significant differences in overall survival or symptom control noted among the regimens. conducted a randomized trial that demonstrated a BID regimen of 45 Gy in 30 fractions over three weeks that was superior to 45 Gy in 25 daily fractions; as a result of their study, clinical use of accelerated hyper‐fractionated RT in LD‐SCLC has become more prevalent.11 The NCCTG 95‐20‐53 trial, which included six cycles of EP, with cycles four and five including concurrent chemotherapy and TRT (30 Gy/20 BID fractions, a 2‐week break, and further 30 Gy/20 BID fractions), resulted in a favorable five‐year survival rate of 24%; however, the locoregional failure remained a problem and grade 3 or grade 3+ toxicity were as high as 97%.10 In the RTOG 0239 study, patients with LD‐SCLC were given thoracic radiation to 61.2 Gy over five weeks (daily 1.8 Gy fractions on days 1–22, then BID 1.8 Gy fractions on days 23–33), and the rates of grade 3 esophagitis and local regional failure were 18% and 20%, respectively; the two‐year OS rate of 36.6% did not reach the projected goal.12 The 2014 National Comprehensive Cancer Network (NCCN) recommended the standard doses for QD and BID TRT as 60–70 Gy in 30–35 fractions and 45 Gy in 30 fractions, respectively. Overall survival (OS) was observed from the first day of treatment until death or last follow‐up; progression‐free survival (PFS) was observed from the first day of treatment until progress, death or last follow‐up; and locoregional recurrence‐free survival (LRFS) was observed from the first day of treatment until recurrence, death or last follow‐up. Side effect assessment was graded using the National Cancer Institute Common Toxicity Criteria (version 3.0) during the RT and chemotherapy periods. There were no significant differences in the response rates between the groups. Table 1 shows the main characteristics of the 143 patients; 80 received QD therapy, and 63 BID therapy. The median follow‐up was 27.14 months, with a range of six–62 months until the last follow‐up date (30 August 2014). A value of P < 0.05 was considered significant. Thoracic radiotherapy was performed using a Varian linear accelerator (Varian Medical Systems, Palo Alto, CA, USA). :;O�r� tҝ��ҝE�5zx��I/1��. have recently published data of nearly 6000 patients with different prostate cancer risk groups, all treated with external beam radiotherapy either with standard fractionation (1.8 - 2.0 Gy per fraction; 40% of the patients) or hypofractionation (2.5 - 6.7 Gy per fraction; 60% of the patients). Gy↔uGy 1 Gy = 1000000 uGy » Centigray Conversions: cGy↔rd 1 cGy = 1 rd cGy↔mrd 1 cGy = 1000 mrd cGy↔J/kg 1 J/kg = 100 cGy cGy↔J/g 1 J/g = 100000 cGy cGy↔J/cg 1 J/cg = 10000000 cGy cGy↔J/mg 1 J/mg = 100000000 cGy cGy↔Gy 1 Gy = 100 cGy cGy↔Mgy 1 Mgy = 100000000 cGy To further clarify these issues, Miralbell et al. and you may need to create a new Wiley Online Library account. CALGB 8837 reported the maximum tolerated doses for QD and BID TRT as 70 Gy in 35 fractions and 45 Gy in 30 fractions, respectively.10 Turrisi et al. Both of the target volumes for TRT were similar. There are conflicting reports as to the best method of integrating thoracic radiation with chemotherapy; multi‐institutional cooperative groups have reported results of dose‐escalation studies. 230 Severe keratitis sicca can lead to corneal ulceration and perforation of the globe. As far as dose‐fractionation is concerned, accelerated hyper‐fractionated RT (45 Gy with 1.5 Gy twice daily in 3 weeks) and dose‐escalated conventional RT (60–70 Gy with 2 Gy once daily in 6–7 weeks) have been documented as reliable schedules, and an international randomized trial (CALGB 30610) is currently underway to compare these two schedules concurrent with chemotherapy in the treatment of LD‐SCLC.6 However, the results will not be available for several years. Dose-volume parameters (lung volumes that received 5 Gy, 10 Gy, 20 Gy, 30 Gy, 40 Gy, 50 Gy, and mean … The primary end point was overall survival. However, FRT is logistically inconvenient, requiring multiple visits to an RT center. h�bbd``b`N�W��?�`il� �m "N|l %f0��$�DAD"� Ipe �4 !V2 HL����Ȱd#i���� �� P The evaluation of the DVH‐based parameters of the OARs is shown in Table 2. Working off-campus? The planning target volume (PTV) was defined by the expanding GTV with a 0.8 to 1.5 cm margin. Incidence of progression‐free survival by radiotherapy fractionation pattern. It is possible that MSCC patients could benefit from an escalation of the radiation dose to >30 Gy in 10 fractions (10 × 3 Gy… Of the 143 patients, 107 had died: 62 (77%) patients who had received QD therapy and 45 (71%) who had received BID therapy. When enlarged lymph nodes (greater than 1.0 cm in short axis measurement on CT, or demonstrated positive on the fludeoxyglucose‐positron emission tomography [FDG‐PET]/CT scan) resolved after induction chemotherapy, the previously involved lymph node regions were still included in the radiation target by reviewing the prechemotherapy CT scan. https://www.clinicaltrials.gov/ct2/show/NCT00632853. All fractional doses were given five days each week and the BID dose was given at least six hours between fractions. Treatment response was estimated using CT or PET‐CT after treatment, according to Response Evaluation Criteria in Solid Tumors (version 1.0). The median OS of all patients was 30.4 months: 29.5 months for QD, and 31.4 months for BID therapy ( Figure 1). In the QD group, irradiation was given via conventional radiotherapy with a dose of 60 Gy at 2 Gy per once‐daily fraction. The study was under protocols approved by the institutional review boards of the Shandong Cancer Prevention and Treatment Research ethics committee. In the head and neck region, doses of up to 66 Gy in 33 fractions CT-based planning was encouraged but not mandatory because this technology was not readily available at the time the study was designed. Radiation doses to circulating cells (DCC) were analyzed using MatLab™. Grade 3 esophagitis occurred in 6% of patients receiving QD and 19% of those receiving BID therapy. All of the patients received four to six cycles of platinum plus etoposide. In the QD group, the prescribed dose was 60 Gy in 30 fractions at 2 Gy QD to the PTV. %PDF-1.7 %���� Dan Han and Shaoyu Hao contributed equally. They randomly assigned patients by a 1:2 ratio to a standard (60 Gy) arm or to an adaptive-therapy arm, with dose individualized to 20 Gy mean lung dose, and adapted to residual tumor on the midtreatment FDG-PET/CT. The treatment volume was the tumour and oedema (defined on CT or MRI) with a 3 cm margin (field size). If you do not receive an email within 10 minutes, your email address may not be registered, Baosheng Li, Department of Radiation Oncology, Shandong Cancer Hospital & Institute, 440 Jiyan Road, Jinan, Shandong 250117, China. No significant differences were observed in the comparisons between the parameters of the total lung, ipsilateral lung, contralateral lung, the maximum irradiation dose to the spinal cord, V30 and mean dose to the heart, or V45 and mean esophagus dose (all P > 0.05). Seventy‐seven patients (40 receiving QD and 37 receiving BID radiation) were administered PCI within four weeks of completion of all chemotherapy. The University of Texas Southwestern reported results from their phase I SBRT dose-escalation trial, with 3 dose groups, 30 Gy/3 fractions, 50 Gy/5 fractions, and 60 Gy/5 fractions . Follow‐up after treatment completion was every three months over the first two years and every six months thereafter. Statistical calculations were performed using SPSS version 17.0 (SPSS Inc., Chicago, IL, USA). Three months after treatment, late toxicities were evaluated according to the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer late radiation morbidity scoring schema. At 2 years, local control was 56%, 89%, and 100%. Table 3 shows the response rates of the 143 patients. Necessary treatment measures, such as recombinant human interleukin and granulocyte colony stimulating factor, were provided and blood transfusions were given to patients with grade 4 hemoglobin toxicity (all patients fully recovered from hematologic toxicity). found that the rates of acute esophagitis increased in SCLC patients treated with BID TRT and our results also supported this view.13 The main toxicity problem of the present study was grade 3 esophagitis, affecting 6% versus 19% (QD vs. BID). Data from a total of 143 LD‐SCLC patients treated at the Shandong Cancer Hospital & Institute were retrospectively analyzed. No authors report any conflict of interest. Use the link below to share a full-text version of this article with your friends and colleagues. Chemotherapy and radiotherapy were combined simultaneously. Small cell lung cancer (SCLC) accounts for 10–15% of all lung cancer cases.1 At the time of diagnosis, 30–40% of SCLC patients present with limited disease (LD) that may be contained in a tolerable radiotherapy (RT) volume.2. There were no statistically significant differences in patient characteristics between the two groups. In the present study we compared toxicities, disease control, and survival in patients treated with either once daily (QD) or twice‐daily (BID) RT with platinum‐based chemotherapy at our institution. Although no statistically significant difference was observed in LRFS between the QD and BID groups, there was a trend toward improved local control for the BID group in the present study. Transient effects of eyelash loss and erythema occur at 30 Gy to 40 Gy with ... or equal to 45 Gy in 25 fractions developing a dry eye syndrome compared with 100% for doses above or equal to 57 Gy in 30 fractions. Although this schedule proved to be effective for the treatment of MSCC, 10–27% of MSCC patients have an additional loss of motor function after 30 Gy in 10 fractions (1, 2, 3, 4). Learn about our remote access options, Departments of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan, China, Department of Thoraic Surgery, Shandong Cancer Hospital & Institute, Jinan, China, Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Jinan, China. In the BID group, the prescribed dose was 45 Gy in 30 fractions at 1.5 Gy BID to the PTV. Please check your email for instructions on resetting your password. The National Cancer Institute of Canada Clinical Trials Group, Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited‐disease small‐cell lung cancer, Comparison of once and twice daily radiotherapy for limited stage small‐cell lung cancer, Once‐daily radiotherapy to > or = 59.4 Gy versus twice‐daily radiotherapy to > or = 45.0 Gy with concurrent chemotherapy for limited‐stage small‐cell lung cancer: A comparative analysis of toxicities and outcomes, Standard‐dose versus high‐dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non‐small‐cell lung cancer (RTOG 0617): A randomised, two‐by‐two factorial phase 3 study, Twice‐daily compared with once‐daily thoracic radiotherapy in limited small‐cell lung cancer treated concurrently with cisplatin and etoposide. Although there were no significant differences in OS and LRFS between the QD and BID groups, there was a trend toward improved local control in the BID group. Methods: Seven hundred and sixty-five patients with painful skeletal metastases requiring palliative radiotherapy were entered into a prospective randomised clinical trial comparing 8 Gy single fraction with a multifraction regimen (20 Gy/5 fractions or 30 Gy/10 fractions). 60 Gy in 30 fractions over 6 weeks with cisplatin and etoposide (Grade A) 66 Gy in 33 fractions over 6.5 weeks with cisplatin and etoposide (Grade A) Sequential: 55 Gy in 20 fractions over 4 weeks (Grade A) 60 Gy in 30 fractions over 6 weeks (Grade B) 66 Gy in 33 fractions over 6.5 weeks (Grade B) 54 Gy in 36 fractions treating thrice daily over 12 consecutive days (CHART) (Grade B) OS, PFS, and LRFS were estimated using the Kaplan–Meier method. A dose of 60 Gy in 8 fractions was prescribed to the 90% isodose line. Low-risk 78 Gy in 39 fractions Prostate alone None Intermediate risk 78 Gy in 39 fractions Prostate and proximal SV 6 mos 2 mos before, 2 during and 2 after. 60–64 Gy in 30–32 fractions over 6–6.5 weeks (Grade B) There is robust evidence that radiotherapy with a radiosensitiser using carbogen and nicotinamide or … Differences between the two groups in patient characteristics, toxicity or treatment response were assessed using the t‐test for numerical data and the Fisher exact test or Chi‐square test for categorical data. Results: All patients received 60 Gy in 30 fractions of radiotherapy with concurrent chemotherapy. The CALGB trial 8433, which randomized patients to conventional radiation therapy (60 Gy in 30 fractions) or 2 cycles of cisplatin and vinblastine followed by conventional radiation therapy, demonstrated an improvement in median survival to 13.7 months (compared with 9.6 months for conventional radiation therapy alone) and 5-year overall survival of 17% (compared to 6%). Different treatment traditions have developed, and a variety of current fractionation schedules, ranging from 10 Gy per one fraction to 60 Gy per 30 fractions, are used in clinical practice . Hypofractionation (doses of 2.5 Gy per fraction and above) Two historical randomised trials which compared hypofractionation (52.5–55 Gy in 20 fractions) with control arms of 60–66 Gy in 33 fractions in 6.5 weeks, doses that, by current standards, are low. The planning target volume (PTV) was defined by the expanding GTV with a 0.8 to 1.5 cm margin. The results show a trend towards a lower four-year bNED rate with hypofractionation.14,15 0 This schedule, known as a concomitant boost regimen or hyperfractionation, is used on tumors that regenerate more quickly when they are … After acceptable risks of acute and late effects were found, 74.4 Gy and 79.2 Gy … Incidence of overall survival by radiotherapy fractionation pattern. Preventive (adjuvant) doses are typically around 45–60 Gy in 1.8–2 Gy fractions (for breast, head, and neck cancers). 10,13 Optimal adjuvant dose fractionation will depend upon the anatomical site. Patients recorded pain severity and analgesic requirements on self-assessment questionnaires before treatment, at 2 weeks and at 1, 2, 3, … There was no difference in PCI between the QD and BID groups. The two‐year locoregional recurrence‐free survival (LRFS) rate was 45% versus 63.4% for the QD group versus the BID group, respectively. Inclusion criteria were: Eastern Cooperative Oncology Group (ECOG) performance status of 0–2; life expectancy > 3 months; age less than 75 years; no serious complications, such as hypertension, coronary heart disease, and psychiatric history; a detailed pretreatment assessment including a bone scan and computed tomography (CT) scan of the head, neck, chest, and abdomen, physical examination, electrocardiogram, complete blood count, urinalysis and chemistry tests (including liver and kidney function tests). One hundred and twenty‐seven patients (89%) received chemotherapy and RT concurrently, and 16 (11%) received sequential chemotherapy followed by RT. , once daily (QD); , twice daily (BID). From January 1978 to January 1988, 859 patients with T3-T4, NO-3, MO were randomly allocated to receive either: Group A--60Co 60, 60 Gy in 30 fractions; Group B--60Co, 70.4 Gy in 64 fractions; Group C--60Co, 60 Gy in 30 fractions plus chemotherapy (5 Fu, 250 mg/m2/IV every 2 days). Preventive (adjuvant) doses are typically around 45–60 Gy in 1.8–2 Gy fractions (for breast, head, and neck cancers.) Concurrent chemoradiotherapy represents the standard treatment for patients with LD‐SCLC based on two meta‐analyses in the 1990s.3, 4 Nonetheless, despite the combination of thoracic radiotherapy (TRT) and chemotherapy, SCLC is still characterized by inevitable local failure and distant metastasis as a result of its aggressive nature. Our study was based on a small sample size and potential confounding factors existed, such as patient, tumor, and radiation treatment characteristics. In some cases, two fractions per day are used near the end of a course of treatment. The BED can be used to compare the efficacy of various dose‐fractionation regimens in providing tumor control and survival.9 Compared with the BID group, QD RT resulted in a higher BED of 54.7 Gy to the tumor. Statistically significant differences were found in the rates of both grade 2 or higher esophagitis (P = 0.036) and pneumonitis (P = 0.043) between the QD and BID groups, respectively. Fractionation preferences may have been influenced more by marginal RT capacity locally than any national, cultural, or attitudinal impacts [ 27 ].