80

Queen Mary Hospital, Hong Kong, Hong Kong. Cancer Chemother. Pharmacol. 14: 282-283,

1983. Forty patients with advanced adenocar-

cinema of the lung were treated by two FAM chemotherapy schedules. Group A (20 patients) received Futraful, adriamycin, and mitomy- cin C, and group B (20 patients) received 5-fluorouracil, adriamycin, and mitomycin C. The response/stabilization rate was greater for group B (4 partial responses + 4 cases of stable disease) than for group A (no responders + 5 cases of stable dis- ease), and the median survival was longer for group B (32 weeks) than for group A (22 weeks), although the differences did not reach statistical significance in either case (P > 0.05). Myelotoxicity was mild in both schedules. Further studies of the two FAM schemes at an escalated dose would be worthwhile.

Sequential Methotrexate and 5-Fluorouracil in the Treatment of Non-Small Cell Carci- noma of the Lung. Wood, C.D., Slevin, M.L., Ponder, B.A.J., Wrigley, P.F.M., Department of Medical On- cology, St. Bartholomew's Hospital, London ECIA 7BE, United Kingdom. Eur. J. Cancer Clin. Oncol. 21: 587-589, 1985.

The sequential administration of metho- trexate (MTX) and 5-fluorouracil (5-FU) has been claimed to be synergistic. To investi- gate the potential synergism in non-small cell carcinoma of the lung (NSCCL), 16 pa- tients were treated with a 2-hr infusion of MTX 200 mg/msup 2 followed after 2 hr by 5-FU 1 g/msup 2. All patients had an Eastern Cooperative Oncology Group perfor- mance status of >2 and had received no pre- vious chemotherapy. No responses were seen. This study demonstrates that sequential MTX and 5-FU in this dosage and schedule is ineffective in NSCCL.

Etoposide and Cisplatin Salvage Chemothera- py for Small Cell Lung Cancer. Lopez, J.A., Mann, J., Grapski, R.T., et al. San Antonio Tumor and Blood Clinic, San Antonio, TX 78217, U.S.A. Cancer Treat. Rep. 69: 369-371, 1985.

Thirty patients with previously treated small cell lung cancer received salvage co!u- bination chemotherapy with etoposide and cis-platin. Two complete and six partial responses were observed, for a major response rate of 27%. Responses occurred promptly and sustained palliation was achieved among re- spenders. Myelosuppression was the major dose-limiting toxic effect. A schedule of etoposide (115 mg/msup 2 iv on days 1-3) and cisplatin (25 mg/msup 2 iv on days 1-3 every 28 days) is recommended for further clinical trials.

8, RADIOTHERAPY

Palliative Radiotherapy for Inoperable Carcino- ma of the Lung: Final Report of a RTOG Multi- Institutional Trial. Simpson, J.R., Francis, M.E., Perez-Tamayo, R., et al. Washington University School of Medicine, Division of Radiation Oncology, St. Louis, Me, U.S.A. Int. J. Radiat. Oncol. Biol. Phys. ii: 751-758, 1985.

Between June 1973 and February 1979, 409 pa- tients with inoperable advanced non-oat cell carcinoma of the lung were randomized on RTOG protocol 73-02. Three treatment arms were evalu- ated: 40 Gy split course, 30 Gy continuous cour- se, and 40 Gy continuous course. Patients were also randomized to receive cytoxan or no further therapy following irradiation. Three hundred sixteen patients were evaluable. Palliation of symptoms was achieved in 60% with .25 of the patients becoming symptom-free. Complete regres- sion of local and regional tumor was produced in 15% and partial regression in 26%. There is no significant difference between the treatment arms in these objective response rates. Medican survi- val times were approximately 6 months. No signi- ficant benefit was demonstrated by the adjuvant use of Cytoxan. Although the number of complete responses produced was relatively small, patients achieving a complete response had a significant- ly longer median survival than the remaining pa- tients, i.e., 14.5 months versus 6 months. Sig- nificant toxicity occurred in fewer than 6% of patients. Radiation pneumonitis accounted for the majority of these adverse reactions. Toxici- ty occurred somewhat more often in the group treated with 40 Gy split course therapy. Impli- cations for further studies are discussed.

The Role of R~diation ~lerapy in the l 'ruatment of Small Cell Lung Cancer. Lichter, A.S., Bunn, P.A. Jr., Ihde, D.C., et al. Department of Radiation Therapy, University of Michigan Medical Center, Ann Arbor, MI 48104, U.S.A. Cancer 55 suppl: 2163-2175, 1985.

Patients with small cell lung cancer (SCLC) are candidates for aggressive therapy because of their potential for long-term survival, especial- ly patients with limited-stage disease. Although no treatment protocol can be considered "stan- dard", the best results in limited-stage SCLC ap- pear to be produced by a combination of chemothe- rapy and thoracic irradiation. Ongoing protocols testing the efficacy of thoracic irradiation should be able to settle question of the optimal treatment approach in limited-stage SCLC over the next 1 to 2 years. Careful attention to vo- lume treated and the use of shrinking fields produce the best results with the minimum of toxicity. Treatment of extensive-stage SCLC has not been substantially improved to date with the addition of local systemic irradiation. Prophylactic cranial irradiation reduces the incidence of CNS failure in SCLC and should

be given, at a minimum, to patients