Twice-daily RT for SCLC (Turrisi) (1999)

Limited-stage small cell lung cancer (SCLC) has a poor prognosis, and optimal radiation therapy (RT) dosing and fractionation were unclear. This study aimed to determine if twice-daily thoracic RT improved outcomes compared to once-daily RT in this population.

This was a randomized phase III trial comparing twice-daily (45 Gy in 30 fractions over 3 weeks) versus once-daily (45 Gy in 25 fractions over 5 weeks) thoracic RT, both given concurrently with chemotherapy, in patients with limited-stage SCLC. The primary endpoint was overall survival.

Patients receiving twice-daily RT had significantly improved overall survival compared to those receiving once-daily RT (median survival 23 months vs. 19 months, p=0.04). The 5-year survival rate was 26% with twice-daily RT versus 16% with once-daily RT. There was no significant difference in rates of severe esophagitis or myelosuppression between the two groups.

Twice-daily thoracic radiation therapy given concurrently with chemotherapy is superior to once-daily RT for patients with limited-stage SCLC, improving overall survival.

The study involved a relatively small number of patients and was conducted prior to the routine use of prophylactic cranial irradiation (PCI) and modern imaging techniques for staging.