51O - Early limited-stage small cell lung cancer: Sub-group analysis of the concurrent once-daily versus twice-daily radiotherapy (CONVERT) trial

Date 07 May 2017
Event ELCC 2017
Session SCLC and early stage NSCLC
Topics Small-Cell Lung Cancer
Thoracic malignancies
Surgical oncology
Therapy
Radiation oncology
Presenter Ahmed Salem
Citation Annals of Oncology (2017) 28 (suppl_2): ii17-ii20. 10.1093/annonc/mdx088
Authors A. Salem1, L. Ashcroft2, A. Dagnault3, C. de Metz4, M. Hatton5, I. Locke6, I. Monnet7, L. Padovani8, F. Blackhall9, C. Faivre-Finn9
  • 1Division Of Molecular And Clinical Cancer Sciences, University of Manchester, M20 3LJ - Manchester/GB
  • 2The Christie NHS Foundation Trust, Manchester/GB
  • 3Centre Hospitalier Universitaire Pavillon l'Hôtel-Dieu de Quebec, Quebec City/CA
  • 4Cancer Centre of Southeastern Ontario, Kingston/CA
  • 5Weston Park Hospital Cancer Research Centre, Sheffield/GB
  • 6Royal Marsden Hospital NHS Foundation Trust, London/GB
  • 7CHI de Créteil, Paris/FR
  • 8CHU de Marseille, Marseille/FR
  • 9Division Of Molecular And Clinical Cancer Sciences, University of Manchester, Manchester/GB

Abstract

Background

There is little evidence to guide the management of early limited-stage small cell lung cancer (LS-SCLC). We examined outcome of early LS-SCLC patients treated within a contemporary trial.

Methods

This is an exploratory analysis of early (TNM stage I-II) LS-SCLC patients included in the CONVERT trial. This is a randomized phase III trial that compared twice-daily (45 Gray (Gy) in 30 twice-daily fractions over 3 weeks) and once-daily (66 Gy in 33 daily fractions over 6.5 weeks) radiotherapy starting on day 22 of chemotherapy cycle 1 in good performance score (PS) patients. Chemotherapy consisted of 4-6 cycles of cisplatin and etoposide. Prophylactic cranial irradiation (PCI) was offered if indicated. Radiotherapy was delivered using three-dimensional conformal or intensity modulated technique.

Results

Between 2008 and 2013, 547 patients were recruited to this trial. Five hundred and thirteen patients were eligible for this analysis and 87 (17%) had early disease. Staging flurodeoxyglucose positron emission tomography (FDG-PET) use (68% versus 55.4%, p = 0.05) and baseline PS (PS0 57.5% versus 43.2%, p = 0.04) were different between early and non-early LS-SCLC patients, respectively. Early patients achieved longer overall survival (median 50 versus 25 months, p = 0.001) and time to local (median 40 versus 17 months, p = 0.0017) and metastatic progression (median 49 versus 16 months, p = 0.0004) compared to non-early patients, irrespective of treatment arm. In early patients, there was no significant overall survival difference between treatment arms, p = 0.31. Radiotherapy compliance was significantly higher in early patients (p = 0.004) and these patients were less likely to experience grade ≥3 acute oesophagitis, compared to non-early patients (11% versus 21%, p < 0.005).

Conclusions

Early LS-SCLC patients achieve good long-term survival with minimal acute side-effects following chemo-radiotherapy and PCI. This study guides practice and provides a benchmark for future studies comparing a surgical to a non-surgical approach in this patient cohort.

Clinical trial identification

ISRCTN91927162, NCT00433563

Legal entity responsible for the study

MAHSC-CTU, The Christie NHS Foundation Trust, Manchester, UK

Funding

Cancer Research UK

Disclosure

All authors have declared no conflicts of interest.