Quantitative analysis of tumor shrinkage due to chemotherapy and its implication for radiation treatment planning in limited-stage small-cell lung cancer

Radiation Oncology

Xiao-Long Fu²  Zheng-Fei Zhu²  Jing-Yi Cheng¹  Qi Liu²  Jia-Zhou Wang²  Bing Xia³ 

[1] Department of Nuclear Medicine, Shanghai Cancer Center, Fudan University, Shanghai, China;Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China;Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, China

关键词: Treatment planning;    Radiation therapy;    Chemotherapy;    Small-cell lung cancer;   

Others  :  1152981
DOI  :  10.1186/1748-717X-8-216

 received in 2013-05-22, accepted in 2013-09-03,  发布年份 2013

【 摘 要 】

Background

The optimal timing of chemoradiotherapy in limited-stage small-cell lung cancer (LS-SCLC) hasn’t been established, although evidence from studies supported that patients can benefit from early radiation therapy. The purpose of this study was to quantify tumor shrinkage in response to induction chemotherapy (IC), evaluate the impact of tumor shrinkage on radiation dosimetric parameters and determine its implication for the timing of radiation therapy for patients with LS-SCLC.

Methods

Twenty patients with LS-SCLC who were treated with IC followed by concomitant radiation therapy were investigated retrospectively. Ten patients received 1 cycle of IC, and 10 patients received 2 cycles of IC. Pre-IC CT imaging was coregistered with a simulation CT, and virtual radiation plans were created for pre- and post-IC thoracic disease in each case. The changes in the gross target volume (GTV), planning target volume (PTV) and dosimetric factors associated with the lungs, esophagus and heart were analyzed.

Results

The mean GTV and PTV for all of the patients decreased by 60.9% and 40.2%, respectively, which resulted in a significant reduction in the radiation exposure to the lungs, esophagus and heart. Changes in the PTV and radiation exposure of normal tissue were not significantly affected by the number of chemotherapy cycles delivered, although patients who received 2 cycles of IC had a greater decrease in GTV than those who received only 1 cycle of IC (69.6% vs. 52.1%, p = 0.273).

Conclusions

Our data showed that targeting the tumor post-IC may reduce the radiation dose to normal tissue in patients with LS-SCLC. However, the benefit to the normal tissue was not increased by an additional cycle of IC. These findings suggest that the first cycle of chemotherapy is very important for tumor shrinkage and that initiating thoracic radiation therapy at the second cycle of chemotherapy may be a reasonable strategy for timing of radiation therapy in LS-SCLC treatment.

【 授权许可】

   
2013 Xia et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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