How to Optimize Quality of Life During Thoracic Radiotherapy for LS-SCLC?

Commentary
Video
Conference|American Society for Radiation Oncology Annual Meeting (ASTRO)

Less lymphocyte depletion with twice-daily radiotherapy warrants further assessment to optimize the synergistic effect of radiotherapy and immunotherapy.

The addition of immune checkpoint inhibitors to twice-daily thoracic chemoradiotherapy (CRT) appeared to improve survival outcomes and reduce hematologic toxicities compared with once-daily radiation in limited-stage small cell lung cancer (LS-SCLC), according to a meta-analysis presented at the 2025 American Society of Radiation Oncology (ASTRO) Annual Meeting. Lead study author Bin Gui, MD, spoke with CancerNetwork® about these findings as well as strategies for optimizing quality of life among patients undergoing thoracic radiotherapy.

Gui, resident physician in the Department of Radiation Medicine at Northwell Health Cancer Institute, emphasized the use of radiation dosimetry constraints to minimize the risk of adverse effects. Additionally, he noted how patient education and comprehensive supportive care can play a role in the treatment course.

According to Gui, the reduced lymphocyte depletion reported with twice-daily radiotherapy warranted future research on how radiotherapy may effectively synergize with immunotherapy in this SCLC population. He also called for head-to-head randomized trials comparing different radiotherapy schedules to validate the findings of the meta-analysis he presented at ASTRO.

Based on data from 8 trials including 2827 patients, twice-daily CRT prolonged 2-year overall survival by 13% compared with once-daily radiotherapy (RR, 1.13; 95% CI, 1.06-1.21). In 3 trials that assessed immunotherapy in combination with radiation, investigators noted a 25% increase in 2-year OS with twice-daily CRT (RR, 1.25; 95% CI, 1.13-1.39).

Transcript:

Best practices [for maintaining quality of life] involve radiation dosimetry constraints to prevent [adverse] effects, establishment of new evidence for combining radiotherapy and immunotherapy, patient education, symptom management of [adverse] effects, and comprehensive supportive care. In this study, accelerated radiotherapy with shorter treatment course appears to be safe with reduced hematologic adverse events.

Less lymphocyte depletion observed with twice-daily thoracic radiotherapy warrants further investigation to optimize the synergistic effect of radiotherapy and immunotherapy. Head-to-head randomized trials comparing accelerated radiotherapy—either hyperfractionation or hypofractionation—and conventional fractionation CRT with consolidation immunotherapy are needed to validate these findings.

Reference

Gui B, Akerman M, Sekari J, Plann-Curley B, Parashar B. Should we return to old school in a new era? A meta-analysis of twice daily vs. once daily concurrent chemoradiotherapy for limited-stage small cell lung cancer. Presented at the 2025 American Society of Radiation Oncology (ASTRO) Annual Meeting; September 27 – October 1, 2025; San Francisco, CA.

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