Current management of limited-stage SCLC and CONVERT trial impact: results of the EORTC Lung Cancer Group survey

Abstract

OBJECTIVES: The CONVERT trial showed that twice-daily (BD) concurrent chemoradiotherapy should continue to be considered the standard of care in localised LS-SCLC. A survey was conducted to assess the impact of the CONVERT trial in clinical practice and to identify any relevant research questions for future trials in this setting.

METHODS AND MATERIALS: An EORTC Group online survey of LS-SCLC practice was distributed to the EORTC LCG and to members of several European thoracic oncology societies between April and December 2018.

RESULTS: 198 responses were analysed. The majority of respondents (88%, n?=?174) were aware of the CONVERT trial. Radiation oncologists comprised 56% of all respondents. Once-daily (OD) radiotherapy is still the most commonly used regimen, however the use of concurrent BD radiotherapy increased after the publication of CONVERT (n?=?59/186, 32% prior to and n?=?78/187, 42% after the publication, p?=?0.053). The main reasons for not implementing BD after the CONVERT publication were logistical issues (n?=?88, 44%), inconvenience for patients (n?=?56, 28%), and the absence of a statistical survival difference between the two arms in CONVERT (n?=?38, 19%). Brain MRI was used by 28% during staging but more than half (60%) of the respondents did not routinely image the brain during follow-up. The main research questions of interest in LS-SCLC were 1) integrating novel targeted therapies-immunotherapies (n?=?160, 81%), 2) PCI (+/- hippocampal sparing) vs. MRI surveillance (n?=?140, 71%) and, 3) biomarker driven trials (n?=?92, 46%).

CONCLUSION: Once daily radiotherapy (60-66?Gy in 30-33 fractions) remains the most prescribed radiotherapy fractionation, despite the findings suggested by the CONVERT trial.