THERAPY FOR SMALL-CELL LUNG-CANCER USING CARBOPLATIN, IFOSFAMIDE, ETOPOSIDE (WITHOUT DOSE REDUCTION), MID-CYCLE VINCRISTINE WITH THORACIC AND CRANIAL IRRADIATION

The aim of this study was to assess the efficacy and toxicity of inten sive chemotherapy, administered without dose reduction, with cranial a nd thoracic radiotherapy given when possible as a single fraction in s mall cell lung cancer. 87 patients were eligible on the basis of good performance status, normal or near normal biochemistry and clinical st aging, 73 limited and 14 extensive stage, computed tomography scanning was not mandatory. Six cycles of carboplatin, ifosfamide and etoposid e with vincristine on day 15 at 4 weekly intervals were planned. Dosag es were not reduced in response to myelosuppression. Prophylactic cran ial irradiation (PCI) as a single fraction after the first cycle and t horacic irradiation (when possible as a single fraction) following the third cycle were delivered. Seventy-two per cent of patients complete d the protocol. Complete response rate was 55% and 26% of patients had a partial response. The median nadirs of neutropenia were 0.5 x 10(9) /l and thrombocytopenia 14 x 10(9)/l, with 6% probable treatment-relat ed deaths. Performance status and dyspnoea improved markedly to normal or near normal levels following the second course. Brain metastases o ccurred in 13% of patients. The median survival was 16.2 months with a 2-year survival of 31% (95% confidence interval, 24-41%) for a minimu m follow-up of 26 months. These results compare favourably with other combined modality studies, using multiple radiotherapy fractions with cisplatin-based combinations and dosage reduction for patients staged in more anatomical detail. The toxicity spectrum and efficacy data cou ld lead to the use of this chemotherapy regimen with haematopoietic gr owth factors and, in the future, peripheral blood progenitor cell resc ue.