High-dose, once-daily thoracic radiotherapy (TRT) and standard twice daily TRT were well tolerated by patients with LS-SCLC, although many preferred the convenience of the once-a-day regimen.


 

For patients with limited-stage small cell lung cancer (LS-SCLC), both high-dose, once daily (QD) thoracic radiotherapy (TRT) and standard twice daily (BID) TRT were well tolerated. However, the QD arm had better QOL scores at week 3 and patients reported the regimen to be less inconvenient.

Apar Kishor Ganti, MD, and colleagues conducted an analysis (CALGB 70702 sub-study of the CALGB 30610 trial) comparing patients’ QOL, between the two regimens, in terms of psychological state, physical functioning, and physical symptoms. Results of the study were presented at the 2022 American Society of Clinical Oncology (ASCO) annual meeting, held recently in Chicago.

 

Once Daily Radiotherapy More Convenient for Many

“The CALGB 30610 trial showed that there was no difference in outcomes between radiation administered to 45 Gy twice a day and 70 Gy once a day in patients with LS-SCLC,” Dr. Ganti says. “To help physicians decide which approach they should use, we conducted a QOL analysis of subjects (N=417) enrolled in this study, which demonstrated that both arms were well tolerated. The effects on QOL were worse in the twice-a-day arm 3 weeks into radiation but improved in this group compared to the once-a-day radiation group at 12 weeks following the start of radiation therapy. A large proportion of patients, however, felt that the once-a-day arm was more convenient. Therefore, the implication of this study is that while both arms have similar cancer-specific benefits, the once-a-day regimen is more convenient for patients.”

In the patient-reported outcomes sub-study, CALGB 70702 participants were administered the EQ-5D, ECOG Acute Esophagitis Scale, Hospital Anxiety and Depression Scale (HADS), FACT-L, FACT Trial Outcome Index-Lung Cancer (FACT-L TOI), and FACT-Esophageal Cancer Eating and Swallowing Indices at baseline and a single item assessing difficulty swallowing at baseline and at weeks 3, 5, 7, 12, 26, and 52 after initiating radiation therapy. Treatment inconvenience was also evaluated by patients at these time points. FACT-L TOI and FACT eating and swallowing subscales at 12 weeks were the primary endpoints of CALGB 70702.

 

Future Research Should Include Patient-Reported Outcomes & QOL Assessment

In the sub-study, the patient questionnaire completion rates were 87% at baseline and 71% at week 52. In the QD arm, the FACT-L total score mean worsening was considerably less compared with the BID arm at week 3 (-1.0 vs -7.0; P=.003), and marginally less at week 5 (-5.3 vs -11.0; P=.06). In the QD arm, the FACT-L TOI mean worsening was notably less than in the BID arm at week 3 (-2.9 vs -7.6; P=.003) and greater at week 12 (-7.6 vs -2.8; P=.03). At 3 weeks, the QD arm also had a lesser EQ-5D index mean worsening (-0.04 vs 0.03; P=.002).

In the BID arm at week 3, mean increase in the acute esophagitis score (1.06 vs 2.89; P<.001) and difficulty swallowing (0.39 vs 1.14; P<.001) were notably greater. In the QD arm at week 5, mean worsening in HADS was notably less (-1.99 vs -0.95; P=.03). No other significant differences at the remaining timepoints were observed between the two arms. Patients reported that treatment was inconvenient at 26% (96/376) of assessments across visits in the QD arm, compared with 33% (116/352) in the BID arm (chi-sq P=.03).

“Future research should look into optimizing outcomes for patients with LS-SCLC, which is of paramount importance,” Dr. Ganti concludes. “In addition, future trials should include patient-reported outcomes and QOL studies, so that we understand how our treatments are affecting patients.”