Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer : a Dutch multicenter phase II study

Baas, P..; Belderbos, J.S.A.; Senan, S.; Kwa, H.B.; van Bochove, A.; van Tinteren, H.; Burgers, J.A.; van Meerbeeck, J.P.

doi:10.1038/SJ.BJC.6602979

Title

Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer : a Dutch multicenter phase II study

Author

Baas, P..

Belderbos, J.S.A.

Senan, S.

Kwa, H.B.

van Bochove, A.

van Tinteren, H.

Burgers, J.A.

van Meerbeeck, J.P.

Abstract

To improve the prognosis of limited stage small cell lung cancer ( LS- SCLC) the addition of concurrent thoracic radiotherapy to a platinum- containing regimen is important. In the Netherlands, we initiated a multicenter, phase II study, of the combination of four cycles of carboplatin ( AUC 5), paclitaxel ( 200 mgm (-2)) and etoposide ( 2 x 50 mg orally for 5 days) combined with 45 Gy ( daily fractions of 1.8 Gy). The radiation was given to the involved field and concurrently with the second and third chemotherapy cycle. Patients with a partial or complete response received prophylactic cranial irradiation to a dose of 30 Gy. From January 1999 to December 2001, 37 of the 38 patients with LS- SCLC entered were eligible for toxicity analysis and response. Grade 3 and 4 haematological toxicity occurred in 57% ( 21/ 37) with febrile neutropenia in 24% ( 9/ 37). There were no treatment- related deaths or other grade 4 toxicity. Grade 3 toxicities were oesophagitis ( 27%), radiation pneumonitis ( 6%), anorexia ( 14%), nausea ( 16%), dyspnea ( 19%) and lethargy ( 22%). The objective response rate was 92% ( 95% confidence interval ( CI) 80 - 98%) with a median survival time of 19.5 months ( 95% CI 12.8 - 29.2). The 1-, 2- and 5- year survival rate was 70, 47 and 27%, respectively. In field local recurrences occurred in six patients. Distant metastases were observed in 19 patients of which 13 in the brain. This study indicates that combination chemotherapy with concurrent involved- field radiation therapy is an effective treatment for LS- SCLC. Despite PCl, the brain remained the most important site of recurrence.

Language

English

Source (journal)

The British journal of cancer. - London

Publication

London : 2006

ISSN

0007-0920

DOI

10.1038/SJ.BJC.6602979

Volume/pages

94 :5 (2006) , p. 625-630