B. Jeremic et al., CARBOPLATIN, ETOPOSIDE, AND ACCELERATED HYPERFRACTIONATED RADIOTHERAPY FOR ELDERLY PATIENTS WITH LIMITED SMALL-CELL LUNG-CARCINOMA - A PHASE-II STUDY, Cancer, 82(5), 1998, pp. 836-841
BACKGROUND. It is not clear how well elderly patients with limited sma
ll cell lung carcinoma tolerate intensive chemotherapy, and they have
often been treated with palliative intent. As an alternative strategy,
the authors designed and employed a short term combination regimen co
nsisting of carboplatin and etoposide with accelerated hyperfractionat
ed radiotherapy. METHODS. Seventy-five patients ages greater than or e
qual to 70 years with a Karnofsky performance status of greater than o
r equal to 60 and no other major medical problems, were enrolled in th
is study and 72 were evaluable. The protocol consisted of intravenous
carboplatin (400 mg/m(2)) given on Days 1 and 29, oral etoposide (50 m
g/m(2)) given on Days 1-21 and 29-49, and accelerated hyperfractionate
d radiation at a dose of 1.5 gray (Gy) administered twice daily (total
dose, 45 Gy) starting on Day 1. RESULTS. The median follow-up period
was 61 months. The response rate was 75%, and complete response was ob
served in 57% of the patients. The median survival time was 15 months,
and the 2- and 5-year survival rates were 32% and 13%, respectively.
Acute Grade 3 leukopenia, thrombocytopenia, and esophagitis were obser
ved in 8.3%, 11%, and 2.8% of the patients, respectively. Only one pat
ient experienced Grade 4 acute toxicity (thrombocytopenia). No late to
xicity of Grade 3 or higher was observed. CONCLUSIONS. This combined t
reatment program was tolerable and produced promising long term result
s. Elderly patients should not universally be treated with palliative
intent. Further studies exploring a potentially more effective regimen
are warranted. (C) 1998 American Cancer Society.