Twice-Daily Chemoradiotherapy Boosts Survival in Limited-Stage SCLC

Bin Gui, MD, spoke with CancerNetwork® about key efficacy and safety findings from a meta-analysis of prospective trials assessing twice-daily and once-daily chemoradiotherapy (CRT) among patients with limited-stage small cell lung cancer (SCLC). He and colleagues presented results from this analysis in a poster session at the 2025 American Society for Radiation Oncology Annual Meeting.

Across 8 trials including approximately 3000 patients, Gui, resident physician in the Department of Radiation Medicine at Northwell Health Cancer Institute, noted that survival improved with a twice-daily radiotherapy schedule, even when combining CRT with immunotherapy. Furthermore, there appeared to be no differences in high-grade toxicities of interest when comparing the twice-daily and once-daily regimens.

Data from the poster revealed a 13% improvement in 2-year overall survival (OS) with twice-daily CRT vs a once-daily regimen (risk ratio [RR], 1.13; 95% CI, 1.06-1.21). Additionally, in 3 trials evaluating immunotherapy plus CRT, the 2-year OS rate improved by 25% with the twice-daily schedule (RR, 1.25; 95% CI, 1.13-1.39).

Additional data highlighted that significantly less leukocyte depletion (OR, 0.70; 95% CI, 0.52-0.94) and lymphocyte depletion (OR, 0.39; 95% CI, 0.19-0.78) occurred with twice-daily CRT vs once-daily treatment. Across all evaluable studies, investigators observed no differences in grade 3 or higher esophagitis or pneumonitis with the use of twice-daily or once-daily CRT. Looking ahead, Gui and coauthors noted a need for head-to-head randomized trials comparing once-daily and twice-daily CRT with consolidation immune checkpoint inhibitors to validate these findings.

Transcript:

Eight trials comprising nearly 3000 patients were included for this meta-analysis. We found that twice-daily radiotherapy significantly improved 2-year OS by 13% compared with the once-daily regimen. More importantly, in the subgroup analysis of 3 trials incorporating immunotherapy, 2-year OS was 25% higher with twice-daily radiotherapy.

Across all trials, there were no differences in grade 3 or higher esophagitis or pneumonitis. Also, in the 2 trials that reported lymphocyte counts, twice-daily thoracic radiotherapy was associated with significantly less leukocyte depletion and lymphocyte depletion.

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: 2025 American Society for Radiation Oncology Annual Meeting; September 27-October 1, 2025; San Francisco, CA.