Alternating chemotherapy and twice-daily thoracic radiotherapy in limited-stage small-cell lung cancer

A pilot study of the eastern cooperative oncology group

David H. Johnson, Andrew T. Turrisi, Alex Y. Chang, Ronald Blum, Phil Bonomi, David Ettinger, Henry Wagner

Research output: Contribution to journalArticle

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Abstract

Purpose: This pilot study was undertaken to determine the efficacy and feasibility of alternating cisplatin and etoposide with multiple daily fractions of thoracic radiotherapy (TRT) in patients with limited-stage small-cell lung cancer (SCLC). Patients and Methods: Thirty-four SCLC patients received four courses of cisplatin (30 mg/m2/d × 3) plus etoposide (120 mg/m2/d × 3) (PE) every 3 weeks. TRT was administered twice daily (1.5 Gy per fraction) for 5 consecutive days in the week after cycles 1, 2, and 3 of chemotherapy (total TRT dose, 45 Gy). Patients who achieved a complete response (CR) received one course of late-intensification (LI) treatment consisting of cyclophosphamide (4 g/m2) and etoposide (900 mg/m2). Prophylactic cranial irradiation (PCI) was optional. Results: Nineteen of 32 assessable patients achieved a CR (59%) and 12 had a partial response (38%), for an overall response rate of 97% (95% confidence interval [CI], 84% to 99%). Median survival was 18 months, while 2-year progression-free survival was 47%. Leukopenia ≤ 1,000/μL occurred in 12% of induction treatment cycles. Severe esophagitis was uncommon. Pulmonary fibrosis that was asymptomatic or minimally symptomatic was observed in eight patients (25%). There was one episode of adult respiratory distress syndrome (ARDS) during LI chemotherapy. Life-threatening neutropenia (≤ 500/μL) developed in all patients who underwent LI chemotherapy, with a median duration of 10 days (range, 8 to 19). Two patients died of sepsis during LI chemotherapy. Conclusion: Alternating PE and TRT as performed in this trial is an effective brief induction regimen for limited-stage SCLC. However, this particular regimen did not appear to be substantially different in terms of efficacy or toxicity compared with regimens using concurrent chemotherapy and standard-fraction TRT. LI chemotherapy was associated with unacceptable toxicity and did not appear to have a favorable impact on survival.

Original languageEnglish (US)
Pages (from-to)879-884
Number of pages6
JournalJournal of Clinical Oncology
Volume11
Issue number5
StatePublished - 1993

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Small Cell Lung Carcinoma
Radiotherapy
Thorax
Drug Therapy
Etoposide
Cisplatin
Cranial Irradiation
Survival
Esophagitis
Pulmonary Fibrosis
Adult Respiratory Distress Syndrome
Leukopenia
Neutropenia
Cyclophosphamide
Disease-Free Survival
Sepsis
Confidence Intervals
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Alternating chemotherapy and twice-daily thoracic radiotherapy in limited-stage small-cell lung cancer : A pilot study of the eastern cooperative oncology group. / Johnson, David H.; Turrisi, Andrew T.; Chang, Alex Y.; Blum, Ronald; Bonomi, Phil; Ettinger, David; Wagner, Henry.

In: Journal of Clinical Oncology, Vol. 11, No. 5, 1993, p. 879-884.

Research output: Contribution to journalArticle

Johnson, David H. ; Turrisi, Andrew T. ; Chang, Alex Y. ; Blum, Ronald ; Bonomi, Phil ; Ettinger, David ; Wagner, Henry. / Alternating chemotherapy and twice-daily thoracic radiotherapy in limited-stage small-cell lung cancer : A pilot study of the eastern cooperative oncology group. In: Journal of Clinical Oncology. 1993 ; Vol. 11, No. 5. pp. 879-884.
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abstract = "Purpose: This pilot study was undertaken to determine the efficacy and feasibility of alternating cisplatin and etoposide with multiple daily fractions of thoracic radiotherapy (TRT) in patients with limited-stage small-cell lung cancer (SCLC). Patients and Methods: Thirty-four SCLC patients received four courses of cisplatin (30 mg/m2/d × 3) plus etoposide (120 mg/m2/d × 3) (PE) every 3 weeks. TRT was administered twice daily (1.5 Gy per fraction) for 5 consecutive days in the week after cycles 1, 2, and 3 of chemotherapy (total TRT dose, 45 Gy). Patients who achieved a complete response (CR) received one course of late-intensification (LI) treatment consisting of cyclophosphamide (4 g/m2) and etoposide (900 mg/m2). Prophylactic cranial irradiation (PCI) was optional. Results: Nineteen of 32 assessable patients achieved a CR (59{\%}) and 12 had a partial response (38{\%}), for an overall response rate of 97{\%} (95{\%} confidence interval [CI], 84{\%} to 99{\%}). Median survival was 18 months, while 2-year progression-free survival was 47{\%}. Leukopenia ≤ 1,000/μL occurred in 12{\%} of induction treatment cycles. Severe esophagitis was uncommon. Pulmonary fibrosis that was asymptomatic or minimally symptomatic was observed in eight patients (25{\%}). There was one episode of adult respiratory distress syndrome (ARDS) during LI chemotherapy. Life-threatening neutropenia (≤ 500/μL) developed in all patients who underwent LI chemotherapy, with a median duration of 10 days (range, 8 to 19). Two patients died of sepsis during LI chemotherapy. Conclusion: Alternating PE and TRT as performed in this trial is an effective brief induction regimen for limited-stage SCLC. However, this particular regimen did not appear to be substantially different in terms of efficacy or toxicity compared with regimens using concurrent chemotherapy and standard-fraction TRT. LI chemotherapy was associated with unacceptable toxicity and did not appear to have a favorable impact on survival.",
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T2 - A pilot study of the eastern cooperative oncology group

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N2 - Purpose: This pilot study was undertaken to determine the efficacy and feasibility of alternating cisplatin and etoposide with multiple daily fractions of thoracic radiotherapy (TRT) in patients with limited-stage small-cell lung cancer (SCLC). Patients and Methods: Thirty-four SCLC patients received four courses of cisplatin (30 mg/m2/d × 3) plus etoposide (120 mg/m2/d × 3) (PE) every 3 weeks. TRT was administered twice daily (1.5 Gy per fraction) for 5 consecutive days in the week after cycles 1, 2, and 3 of chemotherapy (total TRT dose, 45 Gy). Patients who achieved a complete response (CR) received one course of late-intensification (LI) treatment consisting of cyclophosphamide (4 g/m2) and etoposide (900 mg/m2). Prophylactic cranial irradiation (PCI) was optional. Results: Nineteen of 32 assessable patients achieved a CR (59%) and 12 had a partial response (38%), for an overall response rate of 97% (95% confidence interval [CI], 84% to 99%). Median survival was 18 months, while 2-year progression-free survival was 47%. Leukopenia ≤ 1,000/μL occurred in 12% of induction treatment cycles. Severe esophagitis was uncommon. Pulmonary fibrosis that was asymptomatic or minimally symptomatic was observed in eight patients (25%). There was one episode of adult respiratory distress syndrome (ARDS) during LI chemotherapy. Life-threatening neutropenia (≤ 500/μL) developed in all patients who underwent LI chemotherapy, with a median duration of 10 days (range, 8 to 19). Two patients died of sepsis during LI chemotherapy. Conclusion: Alternating PE and TRT as performed in this trial is an effective brief induction regimen for limited-stage SCLC. However, this particular regimen did not appear to be substantially different in terms of efficacy or toxicity compared with regimens using concurrent chemotherapy and standard-fraction TRT. LI chemotherapy was associated with unacceptable toxicity and did not appear to have a favorable impact on survival.

AB - Purpose: This pilot study was undertaken to determine the efficacy and feasibility of alternating cisplatin and etoposide with multiple daily fractions of thoracic radiotherapy (TRT) in patients with limited-stage small-cell lung cancer (SCLC). Patients and Methods: Thirty-four SCLC patients received four courses of cisplatin (30 mg/m2/d × 3) plus etoposide (120 mg/m2/d × 3) (PE) every 3 weeks. TRT was administered twice daily (1.5 Gy per fraction) for 5 consecutive days in the week after cycles 1, 2, and 3 of chemotherapy (total TRT dose, 45 Gy). Patients who achieved a complete response (CR) received one course of late-intensification (LI) treatment consisting of cyclophosphamide (4 g/m2) and etoposide (900 mg/m2). Prophylactic cranial irradiation (PCI) was optional. Results: Nineteen of 32 assessable patients achieved a CR (59%) and 12 had a partial response (38%), for an overall response rate of 97% (95% confidence interval [CI], 84% to 99%). Median survival was 18 months, while 2-year progression-free survival was 47%. Leukopenia ≤ 1,000/μL occurred in 12% of induction treatment cycles. Severe esophagitis was uncommon. Pulmonary fibrosis that was asymptomatic or minimally symptomatic was observed in eight patients (25%). There was one episode of adult respiratory distress syndrome (ARDS) during LI chemotherapy. Life-threatening neutropenia (≤ 500/μL) developed in all patients who underwent LI chemotherapy, with a median duration of 10 days (range, 8 to 19). Two patients died of sepsis during LI chemotherapy. Conclusion: Alternating PE and TRT as performed in this trial is an effective brief induction regimen for limited-stage SCLC. However, this particular regimen did not appear to be substantially different in terms of efficacy or toxicity compared with regimens using concurrent chemotherapy and standard-fraction TRT. LI chemotherapy was associated with unacceptable toxicity and did not appear to have a favorable impact on survival.

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