PATIENTS WITH LIMITED-STAGE SMALL-CELL LUNG-CANCER TREATED WITH CONCURRENT TWICE-DAILY CHEST RADIOTHERAPY AND ETOPOSIDE CISPLATIN FOLLOWED BY CYCLOPHOSPHAMIDE, DOXORUBICIN, AND VINCRISTINE

Purpose: A phase II trial in patients with limited-stage small-cell lu ng cancer treated with induction etoposide/cisplatin plus twice-daily chest radiotherapy was conducted in an attempt to increase response ra tes and prolong survival. Patients and Methods: Fifty-four previously untreated patients with limited-stage small-cell cancer were treated w ith etoposide/cisplatin and concurrent radiotherapy at 1.5 Gy twice da ily for 3 weeks to a total dose of 45 Gy. Patients then received three more cycles of etoposide/cisplatin followed by four cycles of vincris tine, doxorubicin, and cyclophosphamide or an individualized chemother apy regimen. Results: Nine patients are alive and free of cancer a med ian of 4 years (range, 2 to 7) from the start of treatment. Thirty-eig ht have held progression of their cancer at a median of 1.2 years (ran ge, 0.5 to 5.4) and all have died of small-cell cancer. Thirteen of th ese 38 patients' (34%) only site of initial relapse was in the CNS and all died of CNS metastases. Five patients died during therapy or from its complications and two patients died of causes other than relapsed small-cell lung cancer and toxicity. The median survival rime is 21.3 months, with an actual survival rate of 83% at 1 year, and actuarial survival rates of 43% at 2 years and 19% at 5 years. Conclusion: This combined modality regimen for patients with limited-stage small-cell l ung cancer results in a a-year survival rate of 43%, but the principal cause of death in these patients is still relapse of the original can cer. Isolated CNS metastases caused more than 30% of the cancer deaths .