Ten-year follow-up of Southwest Oncology Group 8269: a phase II trial of concomitant cisplatin - etoposide and daily thoracic radiotherapy in limitedsmall-cell lung cancer

Purpose: To report the long-term follow-up of Southwest Oncology Group-8269 , a phase II North American cooperative group trial of concurrent cisplatin , etoposide, vincristine (PEV), and thoracic radiotherapy (TRT) for limited small-cell lung cancer (L-SCLC). Methods: 114 eligible patients from 47 in stitutions enrolled between April, 1985 and March 1986. Patients had docume nted L-SCLC. Induction chemotherapy consisted of three cycles of PEV. TRT w as administered at 1.8 Gy/fraction in 25 daily fractions to a total dose of 45 Gy, to begin concomitantly. Consolidative chemotherapy included two cyc les of vincristine, methotrexate, etoposide, doxorubicin and cyclophosphami de. Prophylactic cranial irradiation (PCI) was concurrent with the 3rd cycl e of chemotherapy. The PCI dose was 30 Gy in 15 fractions of 2 Gy/fraction. Results: As of May 2000, 5 of 114 remain alive and progression-free with a minimum follow-up interval of 13.2 years, as of May 2000. The median follo w-up interval is 14.2 years. Thirty eight patients died of causes other tha n SCLC and five patients are still alive and progression-free. Of the remai ning 71 patients dying of SCLC, local failure (LF) occurred in 24% (17 pati ents), distant metastasis (DM) occurred in 35% (25 patients), simultaneous LF and DM occurred in 25% (18 patients). and was indeterminate in 16%) (11 patients). Thus, LF was a component of failure in 49%. Twenty patients had the CNS as the initial site of failure. Eleven patients (10%) developed fat al second primary cancers, including two with acute myelogenous leukemia, t wo with squamous cell lung cancer. one each with breast, pancreas, prostate . renal cell. and myelodysplasia. One patient developed both a melanoma and non-Hodgkin's lymphoma. Conclusion: There are long-term survivors with con comitant TRT and PEV. LF and DM are common. Pattern of failure suggests nee ds to improve local and systemic control. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.