231

small cell lung carcinoma were entered

into two pilot studies alternating 6 cyc- les of combination chemotherapy (~oxorubi- cin 40 mg/m d i; VP16213 75 mg~m d i, 2, 3; Cyclophosphamide 300 mq/m 9 d 3, 4, 5, 6; and Methotrexate 400 mg/m- d 2 - plus folinic2acid rescue - or Cis-plati- num i00 mg/m d 2) with 3 courses of me- diastinal radiotherapy as induction treat- ment. The first course of radiotherapy started i0 days after the second cycle of chemotherapy; there was a 7 day rest between chemotherapy and radiotherapy courses. This 6 month induction treat- ment was followed by a maintenance chemo- therapy. The total mediastinal radiation dose was increased from 4500 rad in the first study to 5500 rad in the second. Both protocols obtained a complete respon- se (CR) rate of greater than 85% (with fiberoptic bronchoscopy and histological verification). Local control at 2 years was 61% in the first study and 82% in the second. Relapse-free survival at 2 years was 32 and 37%, respectively. Toxicity was acceptable. We conclude that our re- sults justify further clinical research in alternating radiotherapy and chemotherapy schedules.

Patients with Small-Cell Lung Cancer Treat- ed with Combination Chemotherapy With or Without Irradiation. Data on Potential Cures, Chronic Toxicities, and Late Rela'~- ses after a Five- to Eleven-Year Follm~- Up. Johnson, B.E., Ihde, D.C., Bunn, P.A. et al. National Cancer Institute-Navy Medi- cal Oncology Branch, Bethesda, MD, U.S.A. Ann. Intern. Med. 103: 430-438, 1985.

We assessed the outcome in 252 patients with small-cell lung cancer 5 to ll years after treatment with combination chemo- therapy, with or without chest and cra- nial irradiation, in National Cancer In- stitute therapeutic trials from 1973 through 1978. Twenty-eight patients (11%) survived free of cancer for 30 months or more. Fourteen patients remain alive without evidence of cancer beyond 5 years (range, 6.4 to 11.3 years), and 7 pa- tients have returned to a lifestyle simi- lar to that before diagnosis. The other 14 patients who were cancer-free at 30 months have developed cancer or died; 6 patients had a relapse, 4 developed or died from non-small-cell lung cancer, and 4 died of unrelated causes. A few patients with small-cell lung cancer (5.6%) may be cured. Thirty-month, cancer-free sur- vival is insufficient to show a cure. Al- though late toxicities are troublesome, they do not outweigh the benefits of pro- longed survival and potential for cure

with modern aggressive therapy in small-

cell lung cancer.

Combination Chemotherapy Followed by Radiation Therapy in Patients With Regional Stage Ill Un- resectable Non-Small Cell Lung Cancer. Fram, R., Skarin, A., Balikian, J. et al. Dana- Farber Cancer Institute, Boston, MA 02115, U.S.A. Cancer Treat. Rep. 69: 587-590, 1985.

A chemotherapy combination of cyclophosphamide, doxorubicin, and cisplatin (CAP) was administered to 30 patients with stage III M0 or M1 (supracla- vicular nodes) unresectable non-small cell lung cancer before and after radiotherapy. All patients had mediastinal metastases and most had T2 or T3 primary lesions. The response rate (complete plus partial) after two cycles of CAP was 47%, which increased to 66% (24% complete response rate) following radiotherapy. The overall median survi- val from initiation of chemotherapy was 9 months. CNS relapse occurred in five (26%) of 19 respond- ing patients who did not receive prophylactic cranial irradiation in the early part of the study.

Combined Chemotherapy (Vindesine, Lomustine, Cis- platin, and Cyclophosphamide) and Radical Radio- therapy in Inoperable Nonmetastatic Squamous Cell Carcinoma of the Lung. Le Chevalier, T., Arriagada, R., Baldeyrou, P. et al. Department of Medicine, Institute Gustave- Roussy, 94805 villejuif, Cedex, France. Cancer Treat. Rep. 69: 469-472, 1985.

Thirty-three evaluable patients with locally advanced squamous cell carcinoma of the lung were entered in a phase II study combining chemotherapy (vindesine, lomustine, cisplatin, and cyclophos- phamide) and radical radiotherapy. Fourteen pa- tients had an objective response rate of 42% (two complete responses and 12 partial responses) with the first two cycles of chemotherapy. All patients received radiation therapy to the primary tumor, mediastinum, and supraclavicular nodes, and responders to chemotherapy received four additio- nal cycles. On final evaluation, 18 patients (54.5%) achieved complete response and six patients (18%) achieved partial response. The objective response rate was 73% with the combined therapy. The median survival was 15.9 months. Toxicity was acceptable. We conclude that our results justi- fy a phase III study comparing combined treatment versus radiotherapy alone.

Preoperative Laser Photodynamic Therapy in Combi- nation With Operation in Lung Cancer. Kato, H., Konaka, C., Ono, J. et al. Department of Surgery, Tokyo Medical College, Shinjuku-ku, Tokyo 160, Japan. J. Thorac. Cardiovasc. Surg. 90: 420-429, 1985.

Fifteen patients with lung cancer were treated by combined preoperative photodynamic therapy and operation. Preoperative photodynamic therapy was performed for the purpose of either reducing the extent of resection or increasing operability. Clinically, five patients had Stage I disease, two had Stage II, seven had Stage III, and one

had Stage IV. There were two cases of tracheal