Utilisation of thoracic radiotherapy for extensive stage small cell lung cancer in the era of chemoimmunotherapy: Experience from a multisite retrospective cohort study

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Turner, Cassie
Prasetio, Tito
O'Beirne, Shannon
Anderson, Georgena
Hughes, Brett
Vignarajah, Dinesh
Castelli, Joanne
Lwin, Zarnie
Houston, Kathleen
Chan, Bryan
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Gold Coast, Australia

Introduction: Recent trials have demonstrated improved overall survival (OS) with the addition of immunotherapy to platinum/etoposide chemotherapy in extensive-stage small cell lung cancer (ES-SCLC). However, in these studies thoracic radiotherapy (TRT) was excluded, and its role in the current treatment paradigm is unclear. Aim: To examine treatment patterns and outcomes for ES-SCLC treated with chemoimmunotherapy, with a focus on TRT utilisation. Methods: A retrospective audit was undertaken including patients with ES-SCLC treated with chemoimmunotherapy at Sunshine Coast and Metro North Hospital and Health Services from March 2020 to March 2022. Demographics, systemic therapy, radiation data, toxicity and outcomes were recorded. Descriptive statistics and Kaplan Meier survival analysis were utilised. Results: A total of 50 patients were identified across 3 sites (median age 63 years; 56% female). Seven patients (14%) received TRT with doses from 30 to 50 Gy. Most patients had either stage IIIC (n = 2) or IVA (n = 2) disease, and only three had extra-thoracic metastases. Indications for TRT included: persistent bulky thoracic disease following chemoimmunotherapy (n = 3); responding thoracic disease without extra-thoracic metastases (n = 2); concurrent TRT for symptomatic thoracic disease (n = 1) and persistent low volume thoracic disease with low volume extra-thoracic burden (n = 1). In the overall population, progression-free survival at 6-months was 42% (95% CI: 30%–58%). Median OS was 9.24 months, and 6 and 12-month OS were 78% and 36% (95% CI: 25%–53%) respectively. Median OS in those receiving TRT was 15.3 months. TRT was generally well tolerated with only 1 patient experiencing grade ≥3 toxicity (pneumonitis). Contribution to practice: TRT utilisation occurred in a minority of patients undergoing chemoimmunotherapy in ES-SCLC. As expected, TRT when utilised, was in those with minimal or no extra-thoracic disease and/or bulky residual thoracic disease following chemotherapy. TRT appeared well tolerated in these select patients. The role of TRT has yet to be determined in ES-SCLC treated with chemoimmunotherapy.

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Australian Lung Cancer Conference 2023, 15–17 Feb 2023
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Turner, C; Prasetio, T; O'Beirne, S; Anderson, G; Hughes, B; Vignarajah, D; Castelli, J; Lwin, Z; Houston, K; Chan, B, Utilisation of thoracic radiotherapy for extensive stage small cell lung cancer in the era of chemoimmunotherapy: Experience from a multisite retrospective cohort study, Respirology, 2023, 28 (S3), pp. 47-47