INITIAL VERSUS DELAYED ACCELERATED HYPERFRACTIONATED RADIATION-THERAPY AND CONCURRENT CHEMOTHERAPY IN LIMITED SMALL-CELL LUNG-CANCER - A RANDOMIZED STUDY
B. Jeremic et al., INITIAL VERSUS DELAYED ACCELERATED HYPERFRACTIONATED RADIATION-THERAPY AND CONCURRENT CHEMOTHERAPY IN LIMITED SMALL-CELL LUNG-CANCER - A RANDOMIZED STUDY, Journal of clinical oncology, 15(3), 1997, pp. 893-900
Purpose: To perform a randomised study of the optimal timing of thorac
ic radiation (RT) as accelerated hyperfractionated radiation therapy (
ACC HFX RT) in combination with concurrent chemotherapy (CHT) in limit
ed-stage small-cell lung cancer (SCLC), Patients and Methods: Between
1988 and 1992, 107 patients; were enrolled and 103 were assessable, Al
l patients received ACC HFX RT with 1.5 Gy twice daily to 54 Gy plus c
oncurrent daily carboplatin/etoposide (C/E) (30 mg each) and four sequ
ential cycles of cisplatin/etoposide (PE) (30 mg/m(2) and 120 mg/m(2),
respectively, on days 1 to 3), Group I patients (n = 52) received con
current chemoradiation at weeks 1 to 4, and group II (n = 51) at weeks
6 to 9. Patients who showed a complete response (CR) or partial respo
nse (PR) underwent prophylactic cranial irradiation (PCI) at weeks 16
to 17. Results: The median survival time was 34 months in group I and
26 months in group II, and the Kaplan-Meier 5-year survival rates were
30% and 15%, respectively, The difference was almost significant on u
nivariate analysis (P=.052) and was significant on multivariate analys
is (P=.027), Group I patients had a significantly higher local control
rate than group II patients, but there was no difference between the
two groups in distant metastasis rate, There was no difference in the
incidence of acute or late grade 3 to 4 toxicity. Conclusion: Initial
administration of thoracic ACC HFX RT with concurrent C/E seems to pro
duce better local control and survival rates than delayed administrati
on, (C) 1997 by American Society of Clinical Oncology.