Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer : a Dutch multicenter phase II study
Faculty of Medicine and Health Sciences
The British journal of cancer. - London
, p. 625-630
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.