Treatment of small cell carcinoma of lung with combined high dose mediastinal irradiation, whole brain prophylaxis and chemotherapy
Survival of patients with small cell carcinoma of lung, treated on a new combined radiotherapy-chemotherapy protocol, compares favorably with other regimens in the literature and our own previous combined approaches. Radiation, given after induction chemotherapy, consisted of whole brain prophylaxis in all 44 evaluable patients. Patients with limited disease were also treated to the primary and mediastinum to a high dose (5000 rad equivalent) using multiple fields. The new chemotherapy regimen consisted of induction with cyclophosphamide, doxorubicin, and vincristine alternated with cis-platinum and VP-16 (an epipodophyllotoxin) for two cycles, followed by consolidation with low dose cyclophosphamide and vincristine concurrent with irradiation. Patients with limited disease who achieved less than complete response, and all patients with extensive disease were not continued on maintenance chemotherapy. Out of 24 evaluable patients with limited disease, there was 73% survival at 1 year by life-table analysis, measured from treatment initiation. After induction, 16/24 of these limited disease patients were CR (complete responders): 20/24 were CR at completion of their irradiation. Out of 20 evaluable patients with extensive disease, there was 59% survival at 1 year by life-table analysis. Only 4/44 (9%) brain parenchymal relapses occurred, one at 3 months and one at 6 months after local failure and two in patients who did not become CRs, implicating a possible re-seeding mechanism. Five patients had central nervous system relapses outside of brain parenchyma (spinal epidural and leptomeningeal); in three patients this was the initial site of failure. Significant complications included leukopenia (50%) and thrombocytopenia (24%) primarily during induction, and chronic pulmonary fibrosis (25%), possibly contributing to two deaths.
- Research Organization:
- Memorial Sloan-Kettering Cancer Center, New York, NY
- OSTI ID:
- 6422080
- Journal Information:
- Int. J. Radiat. Oncol., Biol. Phys.; (United States), Vol. 7:4; Conference: Annual meeting of the American Radium Society, Philadelphia, PA, USA, 30 Apr 1980
- Country of Publication:
- United States
- Language:
- English
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62 RADIOLOGY AND NUCLEAR MEDICINE
BLOOD PLATELETS
BIOLOGICAL RADIATION EFFECTS
CHEMOTHERAPY
SIDE EFFECTS
FIBROSIS
RADIOINDUCTION
LEUKOCYTES
LEUKOPENIA
LUNGS
RADIOTHERAPY
BRAIN
CARCINOMAS
EXTERNAL IRRADIATION
PATIENTS
PREVENTIVE MEDICINE
RADIOSENSITIVITY
SURVIVAL CURVES
BIOLOGICAL EFFECTS
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
CENTRAL NERVOUS SYSTEM
DISEASES
HEMIC DISEASES
IRRADIATION
MATERIALS
MEDICINE
NEOPLASMS
NERVOUS SYSTEM
NUCLEAR MEDICINE
ORGANS
PATHOLOGICAL CHANGES
RADIATION EFFECTS
RADIOLOGY
RESPIRATORY SYSTEM
THERAPY
560151* - Radiation Effects on Animals- Man
550603 - Medicine- External Radiation in Therapy- (1980-)