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Radiation therapy in small cell lung cancer: a national Italian survey

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Abstract

Introduction

Radiation therapy plays an important role in the management of SCLC both in curative and palliative setting, however, conflicting data from clinical trials incite debate over the appropriate use of radiation therapy regarding prophylactic cranial irradiation (PCI) and/or thoracic consolidative in extensive-stage SCLC (ES-SCLC). This survey is conducted to evaluate the current pattern of care among Italian radiation oncologists.

Methods

In June 2016, all Italian radiation oncologists were invited to a web-based survey. The survey contained 34 questions regarding the role of RT in SCLC. Questions pertaining the role of RT in the clinical management of both limited-stage (LS) and ES-SCLC were included.

Results

We received 48 responses from Italian radiation oncologists. More than half of respondents had been practicing for more than 10 years after completing residency training and 55% are subspecialists in lung cancer. Preferred management of LS-SCLC favored primary concurrent chemoradiotherapy (89%), even if the 36.9% usually delivered RT during or after the cycle 3 of chemotherapy, due to organizational issues. The most common dose and fractionation schedule in this setting was 60 Gy in 30 once-daily fractions. Furthermore, almost all respondents recommended PCI in patients with LS-SCLC. For ES-SCLC scenario, chemotherapy was defined the standard treatment by all respondents. PCI was recommended in ES-SCLC patients with thoracic complete remission (63% of respondents), with thoracic partial response (45%) and with thoracic stable disease (17%) after first-line chemotherapy. Lastly, the thoracic consolidative RT was recommended by 51% of respondents in patients with ES-SCLC in good response after first-line chemotherapy and a great variability was shown in clinical target volume definition, doses and fractionation schedules.

Conclusions

Our analysis showed a high adherence to current guidelines among the respondents in regard to chemoradiation approach in LS-SCLC patients and to PCI indications and doses. The great variability in radiation therapy doses and volumes in the thoracic consolidative radiotherapy in ES-SCLC is concerning. Future clinical trials are needed to standardize these treatment approaches to improve treatment outcomes among patients with ES-SCLC.

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Funding

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Authors and Affiliations

  1. Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera Arcispedale S Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123, Reggio Emilia, Italy

    Patrizia Ciammella & Giorgia Timon

  2. UOC Radioterapia Oncologica, AOU Policlinico di Modena, Modena, Italy

    Alessio Bruni

  3. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy

    Davide Franceschini

  4. Radiation Oncology Department, Spedali Civili Brescia, P.le Spedali Civili, 1, Brescia, Italy

    Paolo Borghetti

  5. Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar, Verona, Italy

    Nicolò Giaj-Levra

  6. Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy

    Carlo Greco

  7. Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy

    Vieri Scotti

  8. Radiation Oncology Department, CRO Aviano, Aviano, Italy

    Marco Trovo

Authors
  1. Patrizia Ciammella
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  2. Giorgia Timon
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  3. Alessio Bruni
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  4. Davide Franceschini
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On the behalf of Associazione Italiana Radioterapia Oncologica (AIRO)

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Correspondence to Patrizia Ciammella.

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All authors disclose no actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations that could inappropriately influence their work.

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Ciammella, P., Timon, G., Bruni, A. et al. Radiation therapy in small cell lung cancer: a national Italian survey. Radiol med 123, 554–560 (2018). https://doi.org/10.1007/s11547-018-0868-5

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