High-Dose Twice-Daily Thoracic Radiotherapy for Limited-Stage Small-Cell Lung Cancer: A Real-World Retrospective...

Hyperfractionated thoracic radiotherapy (RT) is a standard component of curative treatment for limited-stage small-cell lung cancer (LS-SCLC). While 45 Gy in 30 twice-daily fractions remains the most validated regimen, recent Phase II data suggest that dose-escalated RT using 60 Gy in 40 fractions may improve outcomes. However, real-world data on this intensified regimen remain scarce.

We conducted a retrospective cohort study of LS-SCLC patients treated with 60 Gy in 40 twice-daily fractions and concurrent platinum-etoposide chemotherapy at two tertiary centers. Modern radiation techniques were employed. Key outcomes included overall survival (OS), progression-free survival (PFS), patterns of failure, and treatment-related toxicity.

Thirteen patients were included in the analysis. The median age at diagnosis was 59 years; 61.5% were female. At a median follow-up of 15 months, the 2-year OS rate was 71.4%, and the median OS was 30.9 months. The overall response rate was 60%. Most failures were distant; only one local failure was observed. Acute grade ≥3 esophagitis occurred in 7.6%, and no patients experienced grade ≥2 pneumonitis. Hematologic toxicity, particularly neutropenia, was frequent but manageable. No treatment-related deaths occurred.

In this cohort, delivery of dose-escalated twice-daily thoracic radiotherapy using contemporary techniques was feasible and associated with acceptable toxicity in routine clinical practice. Survival outcomes were comparable to those reported in phase II studies of this approach. These findings warrant confirmation in larger, multi-institutional, or registry-based studies.