Concurrent chemotherapy/radiotherapy for limited small-cell lung carcinoma: a Southwest Oncology Group Study.

Abstract

The Southwest Oncology Group (SWOG) has conducted a phase II study to explore the efficacy and toxicity of initial, concurrent use of radiation therapy with cisplatin, etoposide (VP-16), and vincristine in limited-stage small-cell carcinoma of the lung. Two courses of cisplatin, VP-16, and vincristine chemotherapy were given with concurrent radiotherapy (XRT) to the primary tumor to a total dose of 4,500 cGy. Elective brain XRT was given to all patients concurrent with a third course of cisplatin/VP-16 therapy. Consolidation chemotherapy consisting of vincristine, methotrexate, and VP-16 alternating with Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) and cyclophosphamide, was given for 12 weeks following the initial induction chemotherapy/XRT program. Patients with a complete response had all therapy discontinued. Among 154 eligible patients treated, the complete response rate was 56%, with a partial response rate of 27%. The median survival is 17.5 months with an estimated 30% survival rate at 4 years from initiation of treatment. Combined modality toxicities were acceptable with the predominant toxicity being moderate to severe leukopenia and mild radiation esophagitis. The results of this treatment program appear superior to any previously reported by our group and compare favorably to those in the literature at large.

Prognostically orientated multimodality treatment including surgery for selected patients of small-cell lung cancer patients stages IB to IIIB: Long-term results of a phase II trial

“…With mature longterm follow-up, the median survival for the whole patient cohort of 36 months and an actuarial survival rate of 46% at 5 years are clearly encouraging. So far, the best results for SCLC patients have been reported from combined (concurrent) chemoradiation protocols with median survival between 18 and 25 months and 5-year survival of 15-25%, but these were groups with limited disease, not generally excluding positive pleural effusions or involved supraclavicular nodes (McCracken et al, 1990;Turrisi et al, 1992). Twice daily thoracic radiotherapy -included early in the treatment -has been convincingly demonstrated to have an effect on both local control and long-term survival (Turrisi et al, 1999).…”

“…Similar to other solid tumours, surgery may represent the most effective local treatment for dealing with residual disease at the bulky primary tumour, even though we do not know which patient subgroups will eventually profit concerning local control, survival, long-term survival or even cure (Choi et al, 1997). On this background, we started a phase II trial in selected SCLC patients, mostly stages IIB, IIIA and IIIB surgically staged by mediastinoscopy, in whom best results in recent concurrent chemoradiation protocols have been reported with 15-26% 5-year survival rates (McCracken et al, 1990;Turrisi et al, 1999). Aim of the study was to evaluate feasibility, toxicity and efficacy of a prognostically orientated approach in patients consecutively conferred to our institution.…”

Population-based outcomes for small cell lung cancer: impact of standard management policies in British Columbia

“…With chemotherapy alone approximately 9% of patients with limited stage disease (LSCLC) will be long-term survivors [5,6]. This improves to 20-25% with integrated chemoradiation [7][8][9][10][11][12][13]. Patients with extensive stage disease (ESCLC) have a significantly worse outcome with only 1-2% surviving after 5 years [14][15][16].…”

Pretreatment serum lactate dehydrogenase as additional staging parameter in patients with small-cell lung carcinoma

“…The patients who present with extensive disease (above 60%) are treated by chemotherapy only. In this group the 2-year survival rate is about 5% (Smith et al 1990;Ihde 1992;Seifter and Ihde 1988;McCracken et al 1990;Pignon et al 1992).…”