Abstracts/Lung Cancer 13 (1995) 323-356 351

radiation therapy as a possible non-cross-resistant systemic treatment was undertaken for patients with extensive stage small cell lung cancer. Methods. The 20 enrolled patients received 7 cycles of cyclopho- sphamide-based chemotherapy. The first cycle consisted of cyclo- phosphamide, doxorubicin, etoposide, vincristine, and lomustine. Subsequent cycles used a regimen of doxorubicin alternating with cisplatin. Thoracic radiation was delivered in a splitcourse fashion during the first week of chemotherapy cycles 5 and 6 (2000 cGy in five fractions during each week). Prophylactic cranial radiation was delivered in a split- course fashion during the first week of chemotherapy cycles 2 and 3 (1700 cGy in 5 fractions during each week). After the 7 cycles, patients received 600 cGy upper hemibody radiation followed by 809 cGy lower hemibody radiation. Results. Nineteen of 20 patients were evaluable for toxicity and response to treatment. Hematologic toxicity accounted for treatment delays or decreased doses in 16 of 19 patients. Thirteen patients completed the initial 7 cycles; progressive disease was the only reason for discontinuing treatment. Two patients had fatal hematologic complications after lower hemibody radiation. Three patients had severe or greater peripheral neurologic toxicity, two had severe central neurologic toxicity, and one had severe cardiac toxicity. Of 19 patients, 9 achieved a complete response; median survival was 11.5 months. Five-year progression free survival and 5-year overall survival were 27% and 16%, respectively. Conclusions. This aggressive regimen is feasible for patients with extensive stage small cell lung cancer; however, hematologic- related mortality after lower hemibody radiation suggests that future investigations should be initiated at lower initial dosea of lower hemibody radiation. Long term survival of the patients suggests that sequentiill hemibcdy radiation treatment warrants further investigation.

must be kept in mind. Our experience with both methods permits assessment of the feasibility of replacing low dose rate brachytberapy with high dose rate brachytherapy. Results with our first I10 patients (group 1) treated with low dose rate brachytherapy (133 procedures) were compared with results with our initial 59 consecutive patients (group 2) treated with high dose rate brachytherapy (161 procedures). In group 1. patients were treated with one or two sessions of 30-60 Gy each calculated at a 1 cm radius. In patients in group 2. we aimed at three weekly sessions of 7 Gy each calculated at a 1 cm radius. External beam irradiation therapy had previously been given to 88% of patients in group I and to 85% of patients in group 2. Laser bronchoscopy was performed in 36% of patients in group 1 and in 24% of patients in group 2 before brachltherapy. Clinical or bronchoscopic improvement was noted in 72% of patients in group 1 and in 85% of patients in group 2 (p > 0.0s). Complication rates were low and comparable. Survival was similar in both groups (median < 6 months). Although both low dose rate and high dose rate brachytherapy appear equally effective in palliation for malignant endobronchial ObstructiOn, we are now practicing the latter exclusively.

Prophylactic cranial irradiation in small cell lung cancer - an update Kristjansen PEG, Hansen HH. Department ojOncologv, Finsen Cente,: Rigshospitalet, Blegdammej 9. DK-2100 Copenhagen. Lung Cancer (Ireland) 1995;12:Suppl 3:S23-40.

Report of a prospective trial - Split course versus conventional radiotherapy in the treatment of non small cell lung cancer Routh A, Hickman BT, Khansur T. 2500 North State Street, Jackson, MS39216 Radiat Med Med Imaging Radiat Oncol 1995;13:115-9.

The role of prophylactic cranial irradiation (PCI) in the management of patients with small cell lung cancer is reviewed, with emphasis on 11 randomised trials. Several interpretive and methodological problems related to PC1 investigations are identified, and it is argued that given the current data PC1 should be considered as an optional treatment component in CR patients, that these authors do not recommend, while other investigators do.

A prospective randomized trial was started in Januq 1982, to compare morbidity and survival of two different radiation regimens for the treatment of non-small cell lung cancer (NSCLC). The trial was closed in December 1988. One group of patients was treated by conventional daily radiation therapy, and the other groupby split course therapy. To maintain uniformity, a single physician staged and treated all patients and noted morbidity during treatment. m hundred seventy- three wnsccutive lung cancer patients were treated. Only patients who completed the full radiation therapy course were included in this study. One hundred fourteen patients were treated with split course therapy, and 159 patients were treated by conventional daily radiation therapy. A few patients did not return for the second course of treatment, which accounts for the different number of patients in the two arms of the study, There was no statistically siguificant difference in survival between the two arms. Median survival for the split course and the continuous fraction therapy regimens was 11.6 months and 10.9 months, respectively. Split course radiation was associated with less morbidity.

Paclitaxel as a radiation sensitiaer in non-small cell lung cancer Choy H, Browne MJ. Department o/Radiation Oncologv, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. Semin Oncol 1995;22:Suppl 6:70-4.

Low dose rate versus high dose rate intralurninal brachytherapy for malignant endobronchid tumors LO TCM, Ginhovich L, Healey GA, Beamis IF Jr, Webb-Johnson DC, Villanueva AG et al. Department ofRadiation Oncologv. L0he.v Clinic, JI ~Uall Rood. Burlington, .Ul OIBOS. Radiother Oncol 1995;35:193- 7.

The new anticancer agent paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has demonstrated in vitro radiation-sensitizing effects. In this phase I study, paclitaxel in escalating doses was administered weekly with concurrent radiation therapy to patients with regionally advanced non- small cell lung cancer (NSCLC). The goal was to determine the maximum tolerated dose of paclitaxel in this combination, to identify toxicities, and to evaluate response. Twenty- seven patients with NSCLC were enrolled into a phase I trial of concurrent paclitaxel and radiation therapy administered as a 3-hour infusion each week for 6 weeks. The paclitaxel doses ranged from 10 to 70 mg/m*/wk. Radiation therapy was delivered with weekly paclitaxel as 40 Gy in 20 fractions to the original volume with a boost of 20 Gy in 10 fractions to the primary tumor. Esophagitis was the dose-limiting toxicity at a maximum tolerated dose of 60 mg/mVwk. The combination of concurrent radiation therapy and weekly outpatient paclitaxel can be safely delivered to patients with NSCLC at a dose of 60 mg/m’. Esophagitis appeared to be the dose-limiting toxicity. A phase II study of concurrent paclitaxel and radiation therapy is under way.

The efficacy of megavoltage imaging in the radical radiotherapy of non-small cell lung cancer

Although the evolution from low dose rate to high dose rate Levine EL, Burt PA, Stout R, Kane B. Christie Hospital NHS Trust, brachytlrerapy for malignant endobronchial malignancies was primarily Manchester M20 9BXBr J Radio1 1995;68:646-8. based on economy. patient convenience, and radiation protection, the Megavoltage imaging (MVI) has been used to obtain digital images difference in therapeutic index. if any, between these two modalities of treatment fields during therapy for non-small cell lung cancer.