The following is a summary of “Thoracic Radiation in Limited Stage Small Cell Lung Cancer: Trends in Radiation Fractionation,” published in the June 2023 issue of the Clinical Lung Cancer by Kazemi et al.

The standard of care for limited-stage small cell lung cancer (LS-SCLC) is thoracic radiotherapy (TRT). Even though initial data supported the use of twice-daily (BID) radiation to a dose of 45 Gy, recent trials have indicated that daily fractionation (QD) to an amount of 60 to 70 Gy is equally effective. This study examines trends in treatment regimens for LS-SCLC patients treated with TRT. The National Cancer Database (NCDB) was queried for LS-SCLC patients treated with TRT between 2004 and 2017 and categorized by QD versus BID fractionation. 

Unknown stage and dose of radiotherapy were exclusion criteria. Researchers used multivariable analyses (MVA) and logistic regression to investigate the factors associated with receiving a particular fractionation schedule. The inclusion criteria were met by 17,453 patients, with 4,996 receiving BID treatment and 12,457 receiving QD treatment. The most prevalent QD dose (48.9%) was 60 Gy. Overall, the fractionation of QD has increased by 1.3% annually. In 2004, 45 Gy BID treatment accounted for 41.4% of all medicines. 

By 2017, 60 Gy QD (45.2%) increased (1.9%/y) to be the dominant fractionation, while 45 Gy BID (24.8%) decreased (-1.4%/y) to be the second most common fractionation. On the MVA, factors influencing one treatment over the other were stratified further. Compared to BID fractionation, QD fractionation has been the preferred TRT regimen for patients with LS-SCLC since 2004, with the proportion of patients receiving QD treatment continuing to rise. Both patient and facility characteristics appear to influence the choice of treatment regimen.

Source: sciencedirect.com/science/article/abs/pii/S1525730423000153