Journal of Clinical Oncology, Vol 1, 242-246, Copyright © 1983 by American Society of Clinical Oncology
Failure of low-dose, total-body irradiation to augment combination chemotherapy in extensive-stage small cell carcinoma of the lung
RO Dillman, SL Seagren and R Taetle
In a pilot study, 21 consecutive eligible patients with extensive-stage
small cell carcinoma of the lung were scheduled for treatment with
combination chemotherapy followed by total-body irradiation (TBI),
prophylactic cranial irradiation, and consolidative chemotherapy. Induction
chemotherapy consisted of VP16-213, vincristine, cyclophosphamide, and
doxorubicin (VOCA). TBI was given as 100 rads in 10 fractions over 2 wk.
Consolidation chemotherapy consisted of cyclophosphamide, methotrexate, and
hexamethylmelamine (CMH). VOCA chemotherapy was well tolerated, with a 79%
response rate in 19 evaluable patients. TBI was successfully given after
four cycles of VOCA without excessive morbidity in 11 patients, although
subsequent CMH chemotherapy in 8 patients has required dose reductions and
some delays in therapy. Unfortunately, TBI did not increase the degree of
response, and 2 patients relapsed during this therapy. Median survival in
this study was 40-44 wk. One patient has survived 78 wk and remains in
remission. TBI can be safely given following induction chemotherapy in
extensive-stage small cell carcinoma of the lung, but it does not appear to
add to the therapeutic benefit of combination chemotherapy alone.
