Concurrent Compared with Sequential Chemoradiotherapy in the Treatment of Patients with Limited Stage Small Cell Lung Cancer

Objective To compare the responses and acute toxicities of concurrent and sequential chemotherapy combined with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy in the treatment of limited stage small cell lung cancer(LS-SCLC).Methods From May 2005 to August 2008,45 patients with LS-SCLC were randomized into concurrent group(group A,23 patients) and sequential group(group B,22 patients).All patients in the two groups received the same 3DCRT or IMRT(50.4～62 Gy in 28～31F).The chemotherapy protocol in the two groups was cis-platin combined with VP-16.Patients in the sequential group began radiotherapy after 4～6 cycles of chemotherapy;whereas patients in the concurrent group received radiotherapy in the first week of chemotherapy.The radiotherapy targets included the primary tumor and the involved lymph nodes.Results The overall response rate(CR +PR)of group A and group B was 95.7% and 86.4% for the primary tumor.Grade 1 or 2 hematopoietic toxicity was observed in 82.6% of patients and grade 3 or 4 in 8.7% in group A,in group B was 77.3%、9.1%,P0.05.grade 1 or 2 acute radiation esophagitis occurred in 78.2% of patients and acute radiation pneumonitis developed in 86.9% in group A,in group B 72.7%、81.8%,P0.05.Grade 3～4 was not observed in two group.12-and 18-month overall survival rate were 82.6% and 69.5% in group A compared with 77.2% and 36.3% in group B,P=0.039.The locally recurrence rate 8.6% in group and 31.8% in group B,P=0.023.Conclusion Concurrent chemotherapy combined with 3DCRT or IMRT is well tolerated.The short term results of concurrent chemoradiotherapy are better than that of sequential chemoradiotherapy in patients with LS-SCLC.