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Previous Volume 340:265-271 January 28, 1999 Number 4 Next

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ABSTRACT

Background For small-cell lung cancer confined to one hemithorax (limited small-cell lung cancer), thoracic radiotherapy improves survival, but the best ways of integrating chemotherapy and thoracic radiotherapy remain unsettled. Twice-daily accelerated thoracic radiotherapy has potential advantages over once-daily radiotherapy.

Methods We studied 417 patients with limited small-cell lung cancer. All the patients received four 21-day cycles of cisplatin plus etoposide. We randomly assigned these patients to receive a total of 45 Gy of concurrent thoracic radiotherapy, given either twice daily over a three-week period or once daily over a period of five weeks.

Results Twice-daily treatment beginning with the first cycle of chemotherapy significantly improved survival as compared with concurrent once-daily radiotherapy (P=0.04 by the log-rank test). After a median follow-up of almost 8 years, the median survival was 19 months for the once-daily group and 23 months for the twice-daily group. The survival rates for patients receiving once-daily radiotherapy were 41 percent at two years and 16 percent at five years. For patients receiving twice-daily radiotherapy, the survival rates were 47 percent at two years and 26 percent at five years. Grade 3 esophagitis was significantly more frequent with twice-daily thoracic radiotherapy, occurring in 27 percent of patients, as compared with 11 percent in the once-daily group (P<0.001).

Conclusions Four cycles of cisplatin plus etoposide and a course of radiotherapy (45 Gy, given either once or twice daily) beginning with cycle 1 of the chemotherapy resulted in overall two- and five-year survival rates of 44 percent and 23 percent, a considerable improvement in survival rates over previous results in patients with limited small-cell lung cancer.

Source Information

From the Medical University of South Carolina, Charleston (A.T.T.); the University of Wisconsin, Madison (K.K.); St. Vincent's Medical Center, New York (R.B.); LDS Hospital, Salt Lake City (W.T.S.); the University of Washington, Seattle (R.B.L.); M.D. Anderson Cancer Center, Houston (R.K.); H. Lee Moffitt Cancer Center, Tampa, Fla. (H.W.); the University of Medicine and Dentistry of New Jersey, Newark (S.A.); and Vanderbilt University, Nashville (D.H.J.). This study was coordinated by the Eastern Cooperative Oncology Group (Douglas Tormey, M.D., chair), which was joined in an intergroup effort by the Radiotherapy Oncology Group and the Southwest Oncology Group. The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

Address reprint requests to Dr. Turrisi at the Medical University of South Carolina, Department of Radiation Oncology, 171 Ashley Ave., Charleston, SC 29425, or at turrisi{at}radonc.musc.edu.

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Extract | Full Text  
N Engl J Med 1999; 340:2002-2004, Jun 24, 1999. Correspondence

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