Dose-intensive therapy for limited-stage small-cell lung cancer: Long-termoutcome

Purpose: To determine progression-free survival (PFS) and overall long-term survival for limited-stage small-cell lung cancer (SCLC) patients aged 60 years or younger who respond to first-line chemotherapy followed by high-do se combination alkylating agents (cyclophosphamide 5,625 mg/m(2), cisplatin 165 mg/m(2), and carmustine 480 mg/m(2)) with hematologic stem-cell suppor t and chest and prophylactic cranial radiotherapy. patients and Methods: Patients were selected on the basis of their continue d response to first-line therapy, their relative lack of significant comorb idity, and their ability to obtain financial clearance. Results: Of 36 patients with stage III SCLC, nine patients (25%) had achiev ed a complete response (CR), 20 had achieved a near-CR, and seven had achie ved a partial response before undergoing high-dose therapy. Toxicity includ ed three deaths (8%). For all patients, the median PFS was 21 months. The 2 - and 5-year survival rates after dose intensification were 53% (95% confid ence interval [CI], 39% to 72%), and 41%(95% CI, 28% to 61%). Of the 29 pat ients who were in or near CR before undergoing high-dose therapy, 14 remain continuously progression-free a median of 61 months (range, 40 to 139 mont hs) after high-dose therapy. Actuarial 2- and 5-year PFS rates were 57% (95 % CI, 41% to 79%) and 53% (95% CI, 38% to 76%). By multivariate analysis, s hort intensive induction chemotherapy wets associated with favorable outcom e (P < .05). Conclusion: Use of high-dose systemic therapy with intensive local-regional radiotherapy was associated with manageable treatment-related morbidity an d mortality. Patients who were in or near CR before intensification are enj oying an unmaintained 5-year PFS rate of 53%. Late complications were infre quent, and most patients returned to full-time work and activity. A randomi sed comparison of this approach and conventional-dose therapy should define the use of dose intensification with hematopoietic support in patients wit h responding limited-stage SCLC. (C) 1999 by American Society of Clinical O ncology.