INITIAL VERSUS DELAYED ACCELERATED HYPERFRACTIONATED RADIATION-THERAPY AND CONCURRENT CHEMOTHERAPY IN LIMITED SMALL-CELL LUNG-CANCER - A RANDOMIZED STUDY

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.