Topics:
Radiation Oncology • Thoracic Malignancies
Is 60 Gy in 40 fractions BID an appropriate regimen to use for LS-SCLC now?
The recent randomized Phase II Scandinavian trial (Gronberg et al.) showed a statistically significant increased 2-year and median overall survival in small cell lung cancer patients treated with high dose BID radiation (60 Gy in 40 fractions) as compared to standard dose BID radiation (45 Gy in 30 fractions). There was also no increase in toxicity with the higher dose.
Has anyone here used this high dose 60 Gy BID regimen? Would you consider it a reasonable regimen to use off protocol?
Answer from: Radiation Oncologist at Academic Institution
My initial concern when this study was initially presented was the presence of an OS benefit with what seemed like no signal of PFS benefit.In the full publication, while the PFS benefit is not statistically significant, there is some separation of curves after the first 6 months, although the P-val...
Answer from: Radiation Oncologist at Community Practice
So as to answer the question and not to bury the lede: IMHO, yes.Here's an XRT-style-vs-XRT-style trial showing a survival advantage. How rare is that in radiation oncology? There are probably less than 10 such trials in medical history (wild guess). I can't recall the last time that outright pure d...
Comments
Radiation Oncologist at Florida Inst. of Research
Not to mention providing another option, with appr...
Not to mention providing another option, with appr...
Answer from: Radiation Oncologist at Academic Institution
We now have two randomised studies (CONVERT and CALGB study) showing that higher dose (66-70 Gy QD conventional fractionation) is not superior to 45 Gy BID. Usually, the decision to give QD vs bid treatment comes down to patient convenience. If a patient does not want to come BID then I recommend 66...
Answer from: Radiation Oncologist at Community Practice
The THORA trial results are certainly intriguing, but worthy of yet additional investigation and corroboration. In addition to previous comments about the OS benefit seen without a concomitant LC, PFS, or MFS benefit, there are a couple of other criticisms that have been leveled against this study t...
Answer from: Radiation Oncologist at Community Practice
Would not do until it becomes standard of care, WITH appropriately approved constraints and adequate follow-up data.
At the end of the day, it's an extra week of treat...