A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis

A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis

Despite evidence for the superiority of twice-daily (BID) radiotherapy schedules, their utilization in practice remains logistically challenging. Hypofractionation (HFRT) is a commonly implemented alternative. We aim to compare the outcomes and toxicities in limited-stage small-cell lung cancer (LS-...

Full description

Bibliographic Details
Main Authors: Michael Yan, Samantha Sigurdson, Noah Greifer, Thomas A. C. Kennedy, Tzen S. Toh, Patricia E. Lindsay, Jessica Weiss, Katrina Hueniken, Christy Yeung, Vijithan Sugumar, Alexander Sun, Andrea Bezjak, B. C. John Cho, Srinivas Raman, Andrew J. Hope, Meredith E. Giuliani, Elizabeth A. Stuart, Timothy Owen, Allison Ashworth, Andrew Robinson, Fabio Ynoe de Moraes, Geoffrey Liu, Benjamin H. Lok
Format: Article
Language:English
Published: MDPI AG 2021-06-01
Series:Cancers
Subjects:
small-cell lung cancer
hypofractionation
radiotherapy
propensity score
Online Access:https://www.mdpi.com/2072-6694/13/12/2895
id doaj-816222ba11bf43a2899ac4812ad43b7f
record_format Article
collection DOAJ
language English
format Article
sources DOAJ
author Michael Yan
Samantha Sigurdson
Noah Greifer
Thomas A. C. Kennedy
Tzen S. Toh
Patricia E. Lindsay
Jessica Weiss
Katrina Hueniken
Christy Yeung
Vijithan Sugumar
Alexander Sun
Andrea Bezjak
B. C. John Cho
Srinivas Raman
Andrew J. Hope
Meredith E. Giuliani
Elizabeth A. Stuart
Timothy Owen
Allison Ashworth
Andrew Robinson
Fabio Ynoe de Moraes
Geoffrey Liu
Benjamin H. Lok
spellingShingle Michael Yan
Samantha Sigurdson
Noah Greifer
Thomas A. C. Kennedy
Tzen S. Toh
Patricia E. Lindsay
Jessica Weiss
Katrina Hueniken
Christy Yeung
Vijithan Sugumar
Alexander Sun
Andrea Bezjak
B. C. John Cho
Srinivas Raman
Andrew J. Hope
Meredith E. Giuliani
Elizabeth A. Stuart
Timothy Owen
Allison Ashworth
Andrew Robinson
Fabio Ynoe de Moraes
Geoffrey Liu
Benjamin H. Lok
A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis
Cancers
small-cell lung cancer
hypofractionation
radiotherapy
propensity score
author_facet Michael Yan
Samantha Sigurdson
Noah Greifer
Thomas A. C. Kennedy
Tzen S. Toh
Patricia E. Lindsay
Jessica Weiss
Katrina Hueniken
Christy Yeung
Vijithan Sugumar
Alexander Sun
Andrea Bezjak
B. C. John Cho
Srinivas Raman
Andrew J. Hope
Meredith E. Giuliani
Elizabeth A. Stuart
Timothy Owen
Allison Ashworth
Andrew Robinson
Fabio Ynoe de Moraes
Geoffrey Liu
Benjamin H. Lok
author_sort Michael Yan
title A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis
title_short A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis
title_full A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis
title_fullStr A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis
title_full_unstemmed A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis
title_sort comparison of hypofractionated and twice-daily thoracic irradiation in limited-stage small-cell lung cancer: an overlap-weighted analysis
publisher MDPI AG
series Cancers
issn 2072-6694
publishDate 2021-06-01
description Despite evidence for the superiority of twice-daily (BID) radiotherapy schedules, their utilization in practice remains logistically challenging. Hypofractionation (HFRT) is a commonly implemented alternative. We aim to compare the outcomes and toxicities in limited-stage small-cell lung cancer (LS-SCLC) patients treated with hypofractionated versus BID schedules. A bi-institutional retrospective cohort review was conducted of LS-SCLC patients treated with BID (45 Gy/30 fractions) or HFRT (40 Gy/15 fractions) schedules from 2007 to 2019. Overlap weighting using propensity scores was performed to balance observed covariates between the two radiotherapy schedule groups. Effect estimates of radiotherapy schedule on overall survival (OS), locoregional recurrence (LRR) risk, thoracic response, any ≥grade 3 (including lung, and esophageal) toxicity were determined using multivariable regression modelling. A total of 173 patients were included in the overlap-weighted analysis, with 110 patients having received BID treatment, and 63 treated by HFRT. The median follow-up was 20.4 months. Multivariable regression modelling did not reveal any significant differences in OS (hazard ratio [HR] 1.67, <i>p</i> = 0.38), LRR risk (HR 1.48, <i>p</i> = 0.38), thoracic response (odds ratio [OR] 0.23, <i>p</i> = 0.21), any ≥grade 3+ toxicity (OR 1.67, <i>p</i> = 0.33), ≥grade 3 pneumonitis (OR 1.14, <i>p</i> = 0.84), or ≥grade 3 esophagitis (OR 1.41, <i>p</i> = 0.62). HFRT, in comparison to BID radiotherapy schedules, does not appear to result in significantly different survival, locoregional control, or toxicity outcomes.
topic small-cell lung cancer
hypofractionation
radiotherapy
propensity score
url https://www.mdpi.com/2072-6694/13/12/2895
work_keys_str_mv AT michaelyan acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT samanthasigurdson acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT noahgreifer acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT thomasackennedy acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT tzenstoh acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT patriciaelindsay acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT jessicaweiss acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT katrinahueniken acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT christyyeung acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT vijithansugumar acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT alexandersun acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT andreabezjak acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT bcjohncho acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT srinivasraman acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT andrewjhope acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT meredithegiuliani acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT elizabethastuart acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT timothyowen acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT allisonashworth acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT andrewrobinson acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT fabioynoedemoraes acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT geoffreyliu acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT benjaminhlok acomparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT michaelyan comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT samanthasigurdson comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT noahgreifer comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT thomasackennedy comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT tzenstoh comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT patriciaelindsay comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT jessicaweiss comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT katrinahueniken comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT christyyeung comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT vijithansugumar comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT alexandersun comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT andreabezjak comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT bcjohncho comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT srinivasraman comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT andrewjhope comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT meredithegiuliani comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT elizabethastuart comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT timothyowen comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT allisonashworth comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT andrewrobinson comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT fabioynoedemoraes comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT geoffreyliu comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
AT benjaminhlok comparisonofhypofractionatedandtwicedailythoracicirradiationinlimitedstagesmallcelllungcanceranoverlapweightedanalysis
_version_ 1721350563636969472
spelling doaj-816222ba11bf43a2899ac4812ad43b7f2021-06-30T23:45:57ZengMDPI AGCancers2072-66942021-06-01132895289510.3390/cancers13122895A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted AnalysisMichael Yan0Samantha Sigurdson1Noah Greifer2Thomas A. C. Kennedy3Tzen S. Toh4Patricia E. Lindsay5Jessica Weiss6Katrina Hueniken7Christy Yeung8Vijithan Sugumar9Alexander Sun10Andrea Bezjak11B. C. John Cho12Srinivas Raman13Andrew J. Hope14Meredith E. Giuliani15Elizabeth A. Stuart16Timothy Owen17Allison Ashworth18Andrew Robinson19Fabio Ynoe de Moraes20Geoffrey Liu21Benjamin H. Lok22Department of Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 5P9, CanadaDepartment of Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 5P9, CanadaDepartment of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USADepartment of Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 5P9, CanadaThe Medical School, University of Sheffield, Sheffield S10 2RX, UKRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaDepartment of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaDivision of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaDepartment of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 0A4, CanadaDepartment of Physiology and Pharmacology, Western University, London, ON N6A 5C1, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaDepartment of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USADepartment of Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 5P9, CanadaDepartment of Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 5P9, CanadaDepartment of Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 5P9, CanadaDepartment of Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 5P9, CanadaDivision of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, CanadaDespite evidence for the superiority of twice-daily (BID) radiotherapy schedules, their utilization in practice remains logistically challenging. Hypofractionation (HFRT) is a commonly implemented alternative. We aim to compare the outcomes and toxicities in limited-stage small-cell lung cancer (LS-SCLC) patients treated with hypofractionated versus BID schedules. A bi-institutional retrospective cohort review was conducted of LS-SCLC patients treated with BID (45 Gy/30 fractions) or HFRT (40 Gy/15 fractions) schedules from 2007 to 2019. Overlap weighting using propensity scores was performed to balance observed covariates between the two radiotherapy schedule groups. Effect estimates of radiotherapy schedule on overall survival (OS), locoregional recurrence (LRR) risk, thoracic response, any ≥grade 3 (including lung, and esophageal) toxicity were determined using multivariable regression modelling. A total of 173 patients were included in the overlap-weighted analysis, with 110 patients having received BID treatment, and 63 treated by HFRT. The median follow-up was 20.4 months. Multivariable regression modelling did not reveal any significant differences in OS (hazard ratio [HR] 1.67, <i>p</i> = 0.38), LRR risk (HR 1.48, <i>p</i> = 0.38), thoracic response (odds ratio [OR] 0.23, <i>p</i> = 0.21), any ≥grade 3+ toxicity (OR 1.67, <i>p</i> = 0.33), ≥grade 3 pneumonitis (OR 1.14, <i>p</i> = 0.84), or ≥grade 3 esophagitis (OR 1.41, <i>p</i> = 0.62). HFRT, in comparison to BID radiotherapy schedules, does not appear to result in significantly different survival, locoregional control, or toxicity outcomes.https://www.mdpi.com/2072-6694/13/12/2895small-cell lung cancerhypofractionationradiotherapypropensity score

Similar Items