Hot Radiotherapeutic Topic Analysis And Hypofractionated Thoracic Radiotherapy For Limited-stage Small-cell Lung Cancer

Part I.Hot Topic Analysis of Radiotherapy for Limited-stage Smallcell Lung Cancer based on Literature MiningPurpose: To find and summarize hot topics and trends of radiotherapy for limited-stage small-cell lung cancer(LS-SCLC)in published literature using text mining.Materials and Method: Medical literature in PubMed from 1979 to 2019 are taken to analyze.Named-Entity Recognition(NER)method is applied to titles and abstracts to select articles about LS-SCLC.Medical Subject Headings(Me SH)combined with MLG-BERT model are used in literature primary classification,and radiotherapyrelated concepts are labeled on them.We take bibliometrics and visualization together to learn about hot topics of radiotherapy in LS-SCLC.Results: There are 891 articles related to LS-SCLC from PubMed.According to the first-level categories(e.g.,basic study,diagnosis,treatments),there are 628 articles about treatments in LS-SCLC.Among them,352 articles are classified into the secondlevel category of radiotherapy.Based on manual verification,the precision reaches to 98.9%.After removing 4 error-classification and 27 abstract-lost texts,finally,321 articles are included in the analysis and labeled with radiotherapy-related concepts.The top labels in these articles are thoracic radiotherapy(287),dose/fractionation(117),toxicity and side effects(106),timing/sequence(79),PCI(75),irradiation field(45),etc.The visualized result using IF shows that literature about dose/fractionation of thoracic radiotherapy were published more often in the high IF journals,and the number of literature kept growing for years.Conclusion: Dose/fractionation of thoracic radiotherapy is still a hotspot for LS-SCLC in recent years.Part II.Long-Term Results and Quality of Life of Limited-stage Small-cell Lung Cancer after Hypofractionated Thoracic RadiotherapyPurpose: To investigate quality of life of long-term survivors with limited-stage smallcell lung cancer(LS-SCLC)after chemotherapy and hypofractionated thoracic radiotherapy(Hypo TRT).Materials and Method: Previously untreated LS-SCLC patients were enrolled from July 2007 to February 2012 in a prospective phase 2 study of Hypo TRT combined with concurrent chemotherapy.We updated a 10-year follow-up.Treatment was composed of an etoposide/cisplatin regimen up to 4-6 cycles and Hypo TRT(55Gy/22 Fx,once daily)initiated at the first day of the second or third cycle of chemotherapy.Patientreported quality of life was measured by EORTC QLQ-C30 and LC13 questionnaires and to measure late toxicities with further inquiry.Results: Up to the last follow-up,there are 15 patients alive,42 dead and 2 lost.The median follow-up of alive patients was 122.1 months.For the whole cohort,the median overall survival(OS)was 29.9 months.The 2-,5-and 10-year OS rates were 61.0%,35.6% and 29.0%.The median progression-free survival(PFS)was 17.8 months.The 2-,5-and 10-year PFS rates were 44.1%,33.9% and 25.9%.The 2-and 5-year localregional recurrence free survival(LRFS)rates were 77.4% and 69.7%.36 patients experienced a progression of disease(PD).At first progression,8(13.6%),25(42.4%)and 3(5.1%)patients encountered local-regional recurrence,distant metastasis and mixed failure,respectively.3 patients developed second primary malignancy.For patients still alive,the patient-reported Qo L(n=11)was acceptable.The overall quality of life was acceptable,and the average score of 6 functioning areas was similar to previously treated cancer patients in east Asian as reported.No severe late radiation morbidity was observed according to physicians' evaluation.Conclusion: Hypo TRT of 55Gy/22 Fx,once daily,with a favorable long-term survival outcome and no severe treatment-related late toxicities,has not decrease the quality of life of long-term survivors with LS-SCLC.Part ?.Preliminary Analysis a Phase ? Study of Accelerated Hypofractionated Thoracic Radiotherapy and Concurrent Chemotherapy in Limited-stage Small-cell Lung CancerPurpose: To investigate whether accelerated hypofractionated thoracic radiotherapy(Hypo TRT)has better therapeutic effect and safety treating LS-SCLC compared with conventional thoracic radiotherapy(Con TRT).Materials and Method: This is a multicenter,prospective,randomized controlled,open labeled phase 3 study.Initially treated patients diagnosed with LS-SCLC were randomly divided into the Hypo TRT group(55Gy/22 fx,once daily)and the Con TRT group(60Gy/30 fx,once daily).Treatment was composed of an etoposide/cisplatin or etoposide/carboplatin regimen up to 4-6 cycles with concurrent thoracic radiotherapy.A total of 266 patients are required to participate.The primary endpoint of study is 3-year overall survival rate,and the secondary endpoint includes treatment-related acute toxicities,2-year progression-free survival rate,and 2-year locoregional recurrence-free survival rate.Results: Up to the mid-term analysis,a total of 109 patients were enrolled,including 53 in Hypo TRT group and 56 in Con TRT group.The baseline clinical characteristics of two groups show no significant difference.The median follow-up time of all patients was 20.3 months,and the median OS had not yet been reached.The median PFS was 13.7 months in Hypo TRT group and 14.2 months in Con TRT group.There is no significant difference of survival observed yet between two groups.There is no significant difference in acute toxicities such as myelosuppression,radiation esophagitis or radiation pneumonia neither.Conclusion: Hypo TRT has not shown better outcome or more acute toxicities than Con TRT.The study still needs recruiting patients and further follow-up.