Abstracts/Lung Cancer 12 (1995) 265-329

Patim~~ ondMefhods Bchveen January 1988 and December 1989,169 patients were divided randomly into the following groups: group I, HFX RT with 1.2 Gy twice daily to a total dose of 64.8 Gy (n = 61); group II, same HFX RT with CHT consisting of 100 mg of wrboplatin (CBDCA) on days 1 and 2 and 100 mg of ctoposide (VP-I 6) on days 1 lo 3 of each week during the RT course (n = 52); and group III, same HFX RT with CHT consisting of 200 mg of CBDCA on days 1 and 2 and 100 mg of VP-16 on days 1 to 5 of the first, third, and title weeks of the RT course (n = 56). ResulIs: The median survival time (MST) was 8 months for group I, 18 months for group U, and 13 months for group UI. The 3-year survival rates were 6.6%, 23%, and l6%, respectively. There was ~1 significant difference in the survival rate between groups I and Il (p = .0027, log-rank test), but not between groups I and IIl (P = .17) or behveen 8m”pS II and IIl (I’ = .14). The mlapsGfree survival rate in gmup Il was also higher than that in group I (P - .0024), which was largely due to improved local e-mtrol in group U patients. Patients in groups iI and IlI showed a higher incidence of acute an&or late high- grade toxicity compared with group I patients, but no patient died of treatment- related toxicity Conclusion: The combination ofHFX RT and continuous CBlXX/ VP-16 CHT was tolerable and substantially increased the survival rate.

Current treatment of forms of small-cell bronchial carcinoma limited totbehemitburas Quoix E. Jung GM, Schumacher C, Morand G, Pauli G. Hopifal Civil. 1. P/ace de I’Hopilal, 67091 Sbvxbourg Cedes. J Med Strasbourg 1994;25:294-7.

Small-xll carcinoma ofthc bronchus accounts for 25% ofall primary bronchial csrcininomas, i.e. 5000 new cases per year in France. At the time ofdiagnosis, 40% appear to be limited to the hcmithorax. Current standard treatment of these limited forms is based upon combination chemotherapy using Cis-Platyl (cisplatin) and VP 16 and early media&m-tumoral radiotherapy, either concomitantly with chemotherapy or in alternation. Surgical treatment is no longer formally contra-indicated but its potential role remains to be defined using a more precise classification, similar to the TNM classitication. The role of prophylactic irradiation of the brain in patients in complete response remains controversial.

ApbareIIIseuclrOf aa&mtedrsdatberPpywithandwMwutenrboplntin in nonsmall cell lung cancer: An interim toxicity analysis of the first 100 patients Ball D, Bishop J, Smith J, Crenean E, O’Brien P, Davis S et al. PeIerMacCUltwn

Cancer Imtimre, 481 Lit& Lonsdale Street Melbourne, Kz. 3000. Int J Radiat OncotBiolPbysl99S:31:267-72.

Purpose: In 1989 we initiated a multicenter randomized trial to determine if aeeelcrated radiothempy with or without concurrent carboplatin improves local control and survival in patients with limited nonsmall cell lung cancer. This interim analysis was performed on the first 100 patients to determine whether the toxicity of the four treatment arms is acceptable. M&rods and Mnteriafs: One hundred patients with limited nonsmall cell lung c~llccr have been randomized to receive one of four treatments: arm I, radiotherapy 60 Gray (Gy) in 30 fractions in 6 weeks; arm II, accelerated radiotherapy 60 Gy in 30 fractions in 3 weeks; arm III, radiotherapy as in arm I plus carboplatin 350 *p/m’ during weeks 1 and 5 of radiotherapy, arm IV, radiotherapy as in arm lI plus carboplatin 350 *g/m’ during week 1. Survival was mcasumd for the group as II whole and treatment-related toxicities in the four arms were compared. Resutts: The estimated median survival for all 100 patients was 17.1 months with 33% estimated survival at 2 years. The major toxicities were hcmatologic and esophagwd. Patients receiving carboplatin had more ncutropenia (p < 0.0001) and thrombocytopenia (p = 0.002) than patients receiving radiotherapy alone, and this was most marked in patients on arm III. Both csrboplatin and accelerated radiotherapy separately caused more severe esophagitis when compared to conventionel radiotherapy alone (p = 0.01 I and p 0.0017, respeetiv~ly). Esophagitis was *me prolonged in patients having accelerated radiotherapy (p < O.ooO1, median duratiDn 3.2 months compared with 1.4 months for patients receiving conventional fractionation). Six patients (23%) treated on arm Ll have required dilatation of esophageal stricture, one dying with a laryngo- esophageal fistula. Conclusion: In patients receiving radiotherapy for unresectablc lung cancer, overall treatment time can be halved and carboplatin administered concurrently with increased but acceptable esophageal and hem&logic toxicity.

Cormrrent~~yforJegeIIIwo-aaleeU~gagr hue R. Takede Y Obayashi K. Kado T. Yamamota H. Himta S ct rd. Deportment of Respiralov Disease. Hyogo Medical Ct. for Adult Direuse. AWiinom&z. Lung Cancer (Japan) 1994;34:955-1001.

In pstientswith unnsaetablestagcIIInon-smallccll lungcancer,weperformed chemotherapy and concurrent thoracic radiotherapy. Thirty-five registered patients w&e intravenously treated with cisplatin (80 *g/m*) on day I and vindcsinc (3 *g/m’) on days 1.3 and were irradiated from days I to 10 with single doses of 2.5 Gy up to a total dosage of20 Gy. Each course lasted 28 days. Patients mxivcd 3 courses, and a total dosage of 60 Gy was delivered. Response to this treatment was cvaluablc in terms of results in 35 patients. Twenty-two patients showed partial response (response rate 62.9%). 10 had no change, and 3 cases had progressive disease. In 7.5 to 37.8 months observation, three PR patients are alive for more than 24 months without recurrence, but eight PR patients died of lccal relapse, and the median survival time was IS.7 months. Throughout this treatment course, grade 4 leukopenia was noted in 66% and grade 3 thrombeqtopenia was absorbed in 3%. However all were reversible condition and no treatment-related death was obxrved However, two cases died due to complications of pulmonary abscess, which occured in the area of radiation pulmonary tibrosis about one year later atIer treatment. Although this concurrent chcmwradiotherapy is a tolerable treatment for non-small cell lung cancer and obtained a good response rate, it did not improve the survival rate.

Carboplatin, epirubicin, etoposide and thoracic radiotherapy in tbe tmttment of localized small cell lungcaoeer Felip E Gallardo E, Del Campa JM, Vidal R, Vera R, Bodi et al. Servicio de Oncologia y Radiotempia. Hospiral General Universilorio. Paseo Valld’Hebmn 119-129, 08035 Barcelona. Oncologia (Spain) 1994;17:53-6.

In this shrdy, 21 small cell lung cancer patients with limited disease, were treated with carboplatin 325 *g/m2 iv day I, epirubicin 50 *g/m’ iv day 1, and etoposidc 100 mgim’ iv days 1 to 3, every 4 weeks, and thoracic radiotherapy. We obtained 71.4% objective rcsponses with 12 complete responses (57.1%) and 3 partial responses (14.3%). Median survival of all patients WBS 12 months, with two-years survival rate of 14.3%. Toxicity consisted mainly of myclosupprcssion. This treatment obtained a similar response rate to other treatments, with moderate toxicity.

A phase I trial of coocmnitant cbemoradiotberapy with cisplatin dose intensification and granulocytwolony stimulating factor sup-port for advanced malignancies of tbe chest Vokes E.E. Haraf D.J. Drinkard L.C. Hoffman P.C. Ferguson M.K. Vogelzang

N.J. et al. The Universily of Chicago. MC-2115. S841 S. Maryland Avenue, Chicago. IL 60637-1470. Cancer Chemother Pharmawl 1995;35:304-312)

Concomitant chemorsdiothcrapy with cisplatin and combination chemotherapy in the neoadjuvant setting have both shown promising results. Purpose: To identify B locally and systemically active concomitant chcmoradiotherapy regimen incorporating high-do= cisplatin, interferon alfa-2a (IFN), fluorouracil (S-FU), hydroxyurea (HU) and radiotherapy. Methods: Phase I cohort design establishing the maximal tolerated dose (MTD) of cisplatin with and without gramdocyte colony stimulating factor (GCSF). For the first six dose levels, a 4-week cycle consisted of escalating doses of cisplatin during weeks 1 and 2, IFN (week I), and 5-FU and HU (week 2) with single daily radiation fractions of 200 cGy during days l-5 of weeks l-3 and no treatment in week 4. When dose-limiting neutmpenia wasencountered, GCSFws added during weeks I, 3, and 4. Finally, to decrease esophagitis, the radiotherapy schedule was altered to 150 cGy twice daily during weeks I and 2, followed by a 2-week break (level 7). Results: Forty-nine patients with refractory chest malignancies were treated. The MTD of this regimen without GCSF ~8s cisplatin 50 mpim’ in weeks I and 2. IFN 5 million Units o/m’ per day on days l-5 in week 1, 5- FU 800 mg/m’ per day for 5 days by continuous infusion, and HU 500 mg every 12 h for 1 I doses during week 2. The addition of GCSF during weeks 1.3, and 4 allowed for escalation of cisplatin to 100 *g/m’ during weeks 1 and 2, with a decreased dose of IFN at 2.5 MU/m’ per day to avoid renal toxicity. Dose- limiting toxicity (DLT) included scverc neutropcnia, thrombocytopenia, and esophagitis in 5 of 13 patients. Increased thrombocytopmia in patients receiving GCSF was not observed. During hypcrfractionatcd radiotherapy (level 7) chemotherapy doses were as above except for a reduction of 5-FU to 600 m&n’