CARBOPLATIN, ETOPOSIDE, AND ACCELERATED HYPERFRACTIONATED RADIOTHERAPY FOR ELDERLY PATIENTS WITH LIMITED SMALL-CELL LUNG-CARCINOMA - A PHASE-II STUDY

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.