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Giving the same total radiation dose twice a day over three weeks instead of once a day over five raised five-year survival from 16 to 26 percent, at the cost of a much sorer gullet.
Turrisi, Kim, Blum and colleagues randomised 417 patients with limited small-cell lung cancer, all receiving four 21-day cycles of cisplatin and etoposide, to 45 Gy of concurrent thoracic radiotherapy given either twice daily over three weeks or once daily over five, starting with cycle 1 of chemotherapy.
It is the trial that defined limited-stage small-cell treatment for twenty-five years, and it is also a study in why a proven regimen can fail to be adopted: twice-daily radiotherapy needs two hospital visits a day for three weeks and causes grade 3 oesophagitis in more than a quarter of patients, so many centres continued once-daily treatment regardless.
The standard of care in limited-stage small-cell lung cancer from 1999 until ADRIATIC added immunotherapy in 2024, and a rare example of a curative gain in a disease that has had almost none.
The biggest single advance in small-cell lung cancer since twice-daily radiotherapy in 1999, and the strongest argument that the disease responds to immunotherapy when it is given at a lower tumour burden.
Treating the brain before the cancer gets there works in small-cell lung cancer, and it is the proof of principle behind every later attempt to prevent rather than treat brain metastases.
Shares Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer, Radiotherapy, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Chemoradiation (chemoradiotherapy, CRT) and the tag lung-evidence.
Shares Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission, Radiotherapy, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Toxicity and quality of life are undervalued and the tag lung-evidence.
Shares Radiotherapy, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Chemoradiation (chemoradiotherapy, CRT), New England Journal of Medicine and the tag lung-evidence.
Shares Radiotherapy, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Etoposide, Cisplatin and the tag lung-evidence.
Shares Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Etoposide, Cisplatin and the tag lung-evidence.
Shares Radiotherapy, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Cisplatin, Lung cancer (all types) and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Surgery and radiotherapy cure most, get least, New England Journal of Medicine, Cisplatin and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Toxicity and quality of life are undervalued, New England Journal of Medicine, Cisplatin and the tag lung-evidence.