Comparison of hyper- and hypofractionated radiation schemes with IMRT technique in small cell lung cancer: Clinical outcomes and the introduction of extended LQ and TCP models.

Abstract

PURPOSE:

To evaluate the outcomes of 45 Gy/15 fractions/once-daily and 45 Gy/30 fractions/twice-daily radiation schemes utilizing intensity-modulated radiation therapy (IMRT) in extensive stage small cell lung cancer (SCLC), and to build up a new radiobiological model for tumor control probability (TCP) considering multiple biological effects.

METHODS:

Fifty-eight consecutive patients diagnosed with extensive stage SCLC, treated with chemotherapy and chest irradiation, were retrospectively reviewed. Thirty-seven received hyperfractionated IMRT (Hyper-IMRT, 45 Gy/30 fractions/twice-daily) and 21 received hypofractionated IMRT (Hypo-IMRT, 45 Gy/15 fractions/once-daily). Local progression-free survival (LPFS) and overall survival (OS) were calculated and compared. An extended linear-quadratic (LQ) model, LQRG, incorporating cell repair, redistribution, reoxygenation, regrowth and Gompertzian tumor growth was created based on the clinical data. The TCP model was reformulated to predict LPFS. The classical LQ and TCP models were compared with the new models. Akaike information criterion (AIC) was used to assess the quality of the models.

RESULTS:

The 2-year LPFS (34.1% vs 27.9%, p = 0.44) and OS (76.9% vs 76.9%, p = 0.26) were similar between Hyper- and Hypo-IMRT patients. According to the LQRG model, the α/β calculated was 9.2 (95% confidence interval: 8.7-9.9) Gy after optimization. The average absolute and relative fitting errors for LPFS were 9.1% and 18.7% for Hyper-IMRT, and 8.8% and 16.2% for Hypo-IMRT of the new TCP model, compared with 29.1% and 62.3% for Hyper-IMRT, and 30.7% and 65.3% for Hypo-IMRT of the classical model.

CONCLUSIONS:

Hypo- and Hyper-IMRT resulted in comparable local control in the chest irradiation of extensive stage SCLC. The LQRG model has better performance in predicting the TCP (or LPFS) of the two schemes.

• Authors: Qi-Wen Li, Bo Qiu, Bin Wang, Jun Zhang, Li Chen, Yin Zhou, Jun-Kun Qin, Su-Ping Guo, Wei-Hao Xie, Zhou-Guang Hui, Ying Liang, Jin-Yu Guo, He Wang, Meng Zhu, Wen-Tong Shen, Long-Yan Duan, Li-Kun Chen, Li Zhang, Hao Long, Yi-Ming Wang, Hui Liu
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 136 Pg. 98-105 (07 2019) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 31015136 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019. Published by Elsevier B.V.

Topics

• Dose Fractionation, Radiation
• Humans
• Linear Models
• Lung Neoplasms (mortality, radiotherapy)
• Probability
• Radiation Dose Hypofractionation
• Radiotherapy, Intensity-Modulated (methods)
• Retrospective Studies
• Small Cell Lung Carcinoma (mortality, radiotherapy)