WCLC 2025 - Posters & ePosters-P3.13.26 Sequencing of Stereotactic Body Radiation Therapy and Chemotherapy in Stage I Small Cell Lung Cancer: Practice Patterns and Outcomes

P3.13.26 Sequencing of Stereotactic Body Radiation Therapy and Chemotherapy in Stage I Small Cell Lung Cancer: Practice Patterns and Outcomes

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This study examines treatment sequencing patterns and survival outcomes in stage I small cell lung cancer (SCLC) patients receiving stereotactic body radiation therapy (SBRT) and chemotherapy, utilizing data from the National Cancer Database (NCDB). Traditionally, radiotherapy (RT) alone for inoperable stage I SCLC frequently fails to control the primary tumor. SBRT, which has proven effective in inoperable stage I non-small cell lung cancer (NSCLC), is increasingly adopted in SCLC, often combined with chemotherapy to improve overall survival (OS).<br /><br />The study cohort included patients treated with SBRT and chemotherapy, divided into two groups based on treatment sequence: SBRT before chemotherapy (n=416) versus SBRT concurrent with or after chemotherapy (n=215). Statistical analyses involved logistic regression for patient characteristics and Kaplan-Meier and Cox proportional hazards methods for survival outcomes.<br /><br />Key findings revealed no statistically significant difference in OS between the two sequencing strategies: median OS was 40.5 months for SBRT before chemo and 35.6 months for SBRT concurrent with or after chemo (p=0.30). Multivariable analysis confirmed sequencing was not associated with survival (HR 1.11, p=0.35). Notably, starting RT before chemotherapy was more common, particularly in the 2019-2020 period, but clinical T2 stage tumors were more likely to receive RT concurrent with or after chemotherapy.<br /><br />Limitations include lack of data on extent of staging workup (e.g., PET-CT), unequal cohort sizes, and exclusion of cases diagnosed from 2021 onward. Future research should explore whether initiating chemotherapy first affects SBRT treatment volumes.<br /><br />In conclusion, SBRT sequencing relative to chemotherapy does not significantly impact survival in stage I SCLC. This suggests flexibility in treatment timing, with clinical factors guiding the order without compromising outcomes.

Asset Subtitle

Henry Park

Meta Tag

Speaker Henry Park

Topic Small Cell Lung Cancer and Neuroendocrine Tumors

Keywords

small cell lung cancer

stage I SCLC

stereotactic body radiation therapy

SBRT

chemotherapy

treatment sequencing

overall survival

National Cancer Database

Kaplan-Meier analysis

Cox proportional hazards