Radiation Therapy in Treating Patients With Extensive Stage Small Cell Lung Cancer

• Comparison of treatment-related adverse events [ Designated as safety issue: Yes ]
• Patterns of failure [ Designated as safety issue: No ]
• Comparison of time to first failure [ Designated as safety issue: No ]
• Evaluation of the percentage of the planned radiotherapy dose to each site [ Designated as safety issue: No ]

RATIONALE: Radiation therapy uses high energy x-rays to kill tumor cells. This may be an effective treatment for extensive stage small cell lung cancer.

PURPOSE: This randomized phase II trial is comparing how well radiation therapy to the brain works when given with or without radiation therapy to other areas of the body in treating patients with extensive stage small cell lung cancer.

OBJECTIVES:

Primary

• To compare the 1-year overall median survival rate in patients with extensive stage small cell lung cancer treated with prophylactic cranial irradiation with vs without consolidative extracranial radiotherapy following platinum-based chemotherapy.

Secondary

• To compare treatment-related adverse events in these patients.
• To evaluate patterns of failure in these patients.
• To compare the time to first failure in these patients.
• To evaluate the percentage of the planned radiotherapy dose given to each site.

OUTLINE: This is a multicenter study. Patients are stratified according to response to prior treatment (complete response vs partial response) and number of metastatic lesions (1 vs 2-3). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients undergo prophylactic cranial irradiation 5 days per week for 2 weeks.
• Arm II: Patients undergo prophylactic cranial irradiation as in arm I. Patients also undergo consolidative extracranial radiotherapy to locoregional and residual metastatic disease 5 days per week for 2-3 weeks.

After completion of study treatment, patients are followed up at 2 weeks; at 1, 2, 6, 9, and 12 months; every 6 months for 2 years; and then annually thereafter.

• Radiation: prophylactic cranial irradiation
  Given 5 days per week for 2 weeks
• Radiation: selective external radiation therapy
  Given 5 days per week for 2-3 weeks

• Experimental: Arm I
  Patients undergo prophylactic cranial irradiation 5 days per week for 2 weeks.
  Intervention: Radiation: prophylactic cranial irradiation
• Experimental: Arm II
  Patients undergo prophylactic cranial irradiation as in arm I. Patients also undergo consolidative extracranial radiotherapy to locoregional and residual metastatic disease 5 days per week for 2-3 weeks.
  Interventions:

  • Radiation: prophylactic cranial irradiation
  • Radiation: selective external radiation therapy

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed extensive stage small cell lung cancer (SCLC) diagnosed within the past 6 months*

  • Has 1-4 extracranial metastatic lesions NOTE: *Diagnosis made before treatment with chemotherapy

• Has completed 4-6 courses of platinum-based chemotherapy within the past 8 weeks AND meets the following criteria:

  • Radiographic partial or complete response to chemotherapy in ≥ 1 site of disease according to RECIST criteria (if radiotherapy has been delivered to primary disease with chemotherapy, there must be complete or partial response in ≥ 1 of the sites that has not been treated with radiotherapy)
  • No progression in any site
• No limited stage SCLC, even if disease progressed
• No brain or CNS metastases

PATIENT CHARACTERISTICS:

• Zubrod performance status 0-2
• ANC ≥ 1,000/mm^3
• Platelets ≥ 75,000/mm^3
• Hemoglobin ≥ 8.0 g/dL (the use of transfusion or other intervention is allowed)
• Serum ALT and AST ≤ 2.5 times upper limit of normal (ULN) (for patients who will receive radiotherapy to the liver)
• Serum bilirubin < 1.5 times ULN (for patients who will receive radiotherapy to the liver)
• Serum creatinine < 1.5 times ULN (for patients who will receive radiotherapy to the kidneys)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

• No severe, active co-morbidity, defined as any of the following:

  • Acute bacterial or fungal infection requiring IV antibiotics at the time of study registration
  • Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of study registration

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Recovered from prior chemotherapy (i.e., toxicities ≤ grade 1 [except for neuropathy and alopecia])
• Thoracic radiotherapy administered concurrently with or before chemotherapy for the current diagnosis allowed (these patients will not receive mediastinal radiotherapy per protocol)
• No prior radiotherapy to the region of this cancer that would result in overlap of radiotherapy fields
• No concurrent chemotherapy