Concurrent Chemoradiation May Improve LS-SCLC Prognosis

"Early [concurrent] CRT provides a significant survival benefit, while late [concurrent] CRT is an acceptable option," according to the study authors.

Administering concurrent chemoradiotherapy (CRT) may improve the prognosis of patients with limited-stage small cell lung cancer (LS-SCLC), with early use demonstrating a significant survival benefit and late use showing potential as an acceptable option, according to findings from a retrospective study published in Thoracic Cancer.1

Among 203 patients with LS-SCLC, the median overall survival (OS) was 28.8 months (95% CI, 28.500-41.433), with investigators noting significant differences in survival depending on the timing of radiotherapy (P = .031). Data showed a median OS of 30.1 months with concurrent CRT, 27.5 months with sequential therapy, and 21.7 months with no radiotherapy.

Early concurrent CRT produced a median OS of 38.3 months vs 29.5 months with late concurrent CRT, with no significant difference in outcomes between groups (HR, 0.624; 95% CI, 0.350-1.110; P = .058). The median progression-free survival (PFS) in each cohort was 15.3 months vs 13.9 months; outcomes were not statistically significantly different (HR, 0.749; 95% CI, 0.434-1.288; P = .249).

Among patients who received prophylactic cranial irradiation (PCI) and those who did not, respectively, the median OS was 36.9 months vs 29.6 months, which demonstrated no significant difference in outcomes (HR, 0.817; 95% CI, 0.578-1.153; P = .266). The median PFS was significantly longer with the use of PCI (16.87 months) vs treatment without PCI (10.93 months; HR, 0.682; 95% CI, 0.487-0.952; P = .034).

“Our study identified that once LS-SCLC is diagnosed, initiating concurrent radiotherapy and chemotherapy is imperative. Early [concurrent] CRT provides a significant survival benefit, while late [concurrent] CRT is an acceptable option,” lead study author Siyuan Yu, from the Department of Pulmonary and Critical Care Medicine at Peking Union Medical College Hospital of Chinese Academy of Medical Sciences in Beijing, China, wrote with coauthors.1 “Whole-brain PCI offers minimal benefits for OS. In addition, prognostic nutritional, platelet to lymphocyte ratio, and neutrophil to lymphocyte ratio values should not be regarded as reliable predictors of OS.”

According to the study authors, most patients with LS-SCLC have a poor prognosis despite how highly sensitive their disease may be to chemotherapy and radiotherapy.2 The authors noted a need to more deeply understand LS-SCLC to lay the groundwork for future immunotherapy consolidation strategies following concurrent CRT. As part of achieving this outcome, investigators comprehensively analyzed a retrospective cohort of patients that spanned 15 years.

Investigators assessed 280 patients with LS-SCLC who underwent systemic treatment between May 2008 and December 2023 at Peking Union Medical College Hospital; 59 patients were ultimately excluded from analysis due to having inaccessible medical records, and 18 patients were excluded due to having incomplete medical records. Study authors collected information on clinicopathological features, cancer-related therapies, laboratory test values, and clinical and prognostic data.

The study’s primary end point was OS based on Kaplan-Meier survival analysis; investigators also evaluated PFS in this population. Additionally, an assessment of factors influencing survival involved the use of Cox regression models.

Most patients were male (80.30%), and most had a smoking index of more than 400 cigarette-years (71.43%). A majority of the population had an ECOG performance status of 0 or 1 (97.04%), right-sided primary tumors (57.64%), stage T4 disease (43.34%), stage N2 disease (47.78%), baseline chemotherapy with carboplatin plus etoposide (79.31%), and receipt of concurrent CRT (64.04%).

The median OS was 24.9 months for patients with recurrence vs 65.8 months in those without, reflecting a significant difference in outcomes (HR, 2.683; 95% CI, 3.012-11.987; P < .001). Among those with disease recurrence in the brain, the median OS was 28.9 months compared with 20.5 months in patients with other sites of recurrence.

Based on multivariate analysis, predictors of significantly increased mortality risk included an ECOG performance status of more than 1 (HR, 3.652; 95% CI, 1.579-8.448; P = .002), N2 disease (HR, 2.872; 95% CI, 1.312-6.286; P = .008), and N3 disease (HR, 2.645; 95% CI, 1.195-5.856; P = .016). Additionally, patients who received sequential radiotherapy experienced an elevated risk of death vs those who had early concurrent CRT (HR, 1.701; 95% CI, 1.125-2.573; P = .012).

References

1. Yu S, Feng X, Li S, et al. Real-world analysis of treatment patterns in limited-stage small cell lung cancer: implications for clinical practice. Thorac Cancer. 2025;16(9):e70070. doi:10.1111/1759-7714.70070
2. Yu G, Zhou J, Dai J, Lian R. Analysis of high‑risk factors for brain metastasis and prognosis after prophylactic cranial irradiation in limited‑stage small cell lung cancer. Oncol Lett. 2024;28(3):422. doi:10.3892/ol.2024.14555