Randomized trial on chest irradiation in extensive disease small cell lung cancer

Chemotherapy is the cornerstone in the treatment of extensive disease small
cell lung cancer (ED-SCLC), and four to six cycles of chemotherapy without
maintenance therapy is current standard. However, survival in patients
presenting with ED-SCLC is poor and has shown little improvement in the past
few decades.
The notable exception was the survival benefit reported in a phase III EORTC
trial evaluating prophylactic cranial irradiation (PCI) versus no PCI following
any response to induction chemotherapy Symptomatic brain metastases were
significantly more frequent in controls (40% versus 15%), more of whom also
died of SCLC (80% versus 68%). More patients in the PCI arm also received
salvage chemotherapy at the time of disease recurrence. PCI is the new standard
of care in all patients with SCLC who respond to chemotherapy.
Intrathoracic tumor control is a major problem in ED-SCLC. Over 75% of patients
have persisting intra-thoracic disease after initial chemotherapy, and about
90% manifest intra-thoracic disease progression at 1 year after completing
initial chemotherapy In a trial reported by Jeremic et al., patients with
ED-SCLC who had a complete response at sites of distant disease, were
randomized to thoracic radiotherapy. The reported median and 5-year survivals,
was far higher than has been reported by any other group for ED-SCLC. This
study has not yet been repeated.
In the absence of promising systemic agents that can improve local response, a
logical step would be to evaluate the role of thoracic irradiation in patients
with ED-SCLC who respond to chemotherapy and to assess the effect on 1 year
survival.

to evaluate the role of thoracic irradiation in patients with ED-SCLC who
respond to chemotherapy and to assess the effect on 1 year survival

This is a multicenter phase III randomized trial. Patients with cytologically or
 histologically proven ED small cell lung cancer 
will be treated with chemotherapy.
Patients with a response will receive prophylactic cranial irradiation and will 
be randomized to receive either thoracic 
irradiation or no further therapy

thoracic irradiation

No extra hospital visists or interventions. Risk for extra toxicity due to
thoracic irradiation