Improving survival with thoracic radiotherapy in patients with small cell lung cancer. The CONVERT and the REST Trials.

摘要

Clinical trials testing systemic therapies in small cell lung cancer (SCLC) have been associated with disappointing results in the last two decades, and so the standard chemotherapy treatment remains platinum and etoposide chemotherapy [1]. On a more optimistic note, major advances have been made since the 1980s with radiotherapy in this disease. These advances include improvements in radiotherapy techniques, the use of prophylactic cranial irradiation (PCI) for all stages of SCLC [2,3] and improved understanding in the combination of chemotherapy and radiotherapy [4]. The standard of care in good performance status limited-stage SCLC is early concurrent chemo-radiotherapy, with the best survival results being achieved with twice daily radiation [4,5]. As a result of the implementation of the best standard of care, the 5 year survival of limited-stage SCLC patients has increased from less than 10% with chemotherapy alone to 25% with early concurrent chemoradiotherapy [4,6]. In extensive-stage disease, chemotherapy is the standard of care. Thoracic radiotherapy is generally given to alleviate symptoms, whereas PCI in extensive-stage SCLC patients who respond to chemotherapy was recently proven to double survival at 1 year [3].