Journal of Clinical Oncology, Vol 5, 592-600, Copyright © 1987 by American Society of Clinical Oncology
Multimodal therapy for limited small-cell lung cancer: a randomized study of induction combination chemotherapy with or without thoracic radiation in complete responders; and with wide-field versus reduced- field radiation in partial responders: a Southwest Oncology Group Study
MS Kies, JG Mira, JJ Crowley, TT Chen, R Pazdur, PN Grozea, SE Rivkin, CA Coltman Jr, JH Ward and RB Livingston
In 1979 we initiated a phase III study in the Southwest Oncology Group
(SWOG) which was designed to determine the value of chest radiation in
limited-stage small-cell lung cancer patients achieving complete response
after induction chemotherapy, and to test the use of wide- field v more
limited-volume radiation in patients with partial responses (PRs) and
patients with stable disease (SD). The induction chemotherapy (VMV-VAC)
consisted of vincristine, 2 mg intravenously (IV) every week for six doses;
methotrexate, 60 mg/m2 IV days 1 and 43; VP-16, 50 mg/m2/d IV days 1 to 5
and 43 to 47; doxorubicin, 60 mg/m2 IV days 22 and 64; and
cyclophosphamide, 1,000 mg/m2 IV days 22 and 64. Four hundred ninety-four
patients were registered, of whom 473 were eligible. Of 466
response-evaluable patients, 153 (33%) achieved complete disease remission
(CR) with chemotherapy. A total of 387 patients entered the consolidation
phase of treatment after chemotherapy and response determination. CR
patients were prospectively randomized to receive chest radiation,
consisting of 4,800 rad administered in a split-course scheme, or to
continue chemotherapy without interruption. The treatment volume was based
on tumor extent before the induction chemotherapy. Maintenance chemotherapy
consisted of cyclophosphamide and VP-16 administered for four cycles before
a period of reinduction chemotherapy consisting of VMV-VAC as described
above. Patients receiving chest radiation therapy were given the same
maintenance and reinduction chemotherapy programs following completion of
the chest radiation. One hundred ninety-one eligible patients achieving PR
or SD status after induction chemotherapy were randomized to a preinduction
treatment volume or to a postinduction reduced tumor volume, with treatment
portals designed according to tumor extent before or after induction
chemotherapy, respectively. After completion of the entire treatment plan,
there were 218 (47%) CRs and 121 (26%) PRs. These figures represent the
greatest response achieved at any point in the treatment program. The
median survival for all eligible patients was 57 weeks (74 weeks for CRs).
Overall survival for CR patients was not different for patients who did or
did not receive chest radiation. However, patterns of tumor relapse were
affected by the chest radiation, as 38 of 42 relapsing patients who did not
receive radiation had intrathoracic recurrences in comparison to only 20 of
36 radiated patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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