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Showed that giving the same dose of radiotherapy twice a day for three weeks, rather than once a day for five, raises the five-year survival of limited-stage small-cell lung cancer from 16 to 26 percent.
Thoracic radiotherapy was known to improve survival in limited-stage small-cell lung cancer, but how to fit it around chemotherapy was unsettled. Intergroup 0096 gave all 417 patients four 21-day cycles of cisplatin and etoposide and randomised them to 45 Gy of concurrent thoracic radiotherapy given either twice daily over three weeks or once daily over five, both starting with cycle 1.
After a median follow-up of almost eight years, median survival was 23 months with twice-daily treatment against 19 months with once-daily (log-rank p=0.04). Two-year survival was 47 against 41 percent and five-year survival 26 against 16 percent. Grade 3 oesophagitis was the price: 27 percent against 11 percent.
The combined two- and five-year survival of 44 and 23 percent was a considerable advance on the previous literature, and twice-daily 45 Gy has been a standard ever since, although many centres use 60 to 66 Gy once daily instead because CONVERT, which compared 45 Gy twice daily with 66 Gy once daily in 547 patients, found no significant survival difference and similar toxicity.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
417 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 5 yearsprimary | 45 Gy twice daily over 3 weeks | - | 26% | - | 0.04 | link |
| 45 Gy once daily over 5 weeks | - | 16% | ||||
| Grade 3 oesophagitis | 45 Gy twice daily over 3 weeks | - | 27% | - | - | link |
| 45 Gy once daily over 5 weeks | - | 11% |
Shares Limited-stage small-cell lung cancer, Etoposide, Cisplatin, Platinum agents.
Shares ADRIATIC, CONVERT, Platinum + etoposide (EP / CE), Limited-stage small-cell lung cancer.
Shares Limited-stage small-cell lung cancer, Etoposide, Cisplatin, Platinum agents.
Shares Limited-stage small-cell lung cancer, Chemoradiation (chemoradiotherapy, CRT), Etoposide, Cisplatin.
Shares Etoposide, Cisplatin, Platinum agents, IMRT / IGRT (modern external beam).
Shares Curative intent vs palliative intent, Limited-stage small-cell lung cancer, Lung cancer (all types), IMRT / IGRT (modern external beam).
Shares Platinum + etoposide (EP / CE), Etoposide, Cisplatin.
Shares Etoposide, Cisplatin, Platinum agents, IMRT / IGRT (modern external beam).