Small-Cell Lung Cancer

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Chemo Completion Vital for Patients With Small-Cell Lung Cancer

NEW YORK (Reuters Health) Aug 28 - In patients with limited-stage, small-cell lung cancer being treated with chemotherapy, survival is not affected if thoracic radiotherapy is administered early or later in the course of chemotherapy (cycle 2 versus cycle 6), results of a British study suggest. Far more relevant, the investigators observed, is that patients do markedly better when they receive the entire dose of chemotherapy.

Other trials comparing the effect of the timing of radiotherapy yielded mixed results, Dr. Allan K. Hackshaw and associates note in their report, published in the Journal of Clinical Oncology for August 20. One trial in particular, the National Cancer Institute of Canada Clinical Trials Group, found superior survival in the early radiotherapy arm.

Dr. Hackshaw, at University College London, Cancer Trials Centre, and his group conducted a randomized trial to replicate the Canadian study as closely as possible. Their 325-patient cohort was undergoing chemotherapy and radiotherapy for the first time, and had limited small cell lung cancer, which the authors defined as within one hemithorax, mediastinum, or ipsilateral supraclavicular fossa.

Chemotherapy, administered in 3-week cycles, was comprised of cyclophosphamide, doxorubicin and vincristine in cycle one, three and five, administered for 1 day. This treatment was alternated with etoposide and cisplatin administered on days 1 to 3 in cycles two, four and six.

Radiation (40 Gy) was delivered in 15 fractions over 3 weeks. Early treatment was initiated in week 3 (n = 159), while late treatment began at week 15 (n = 166).

After median follow-up of 63 months, Dr. Hackshaw's team observed no significant difference in progression-free survival, tumor response, or overall survival between the two arms of the study.

When they compared their trial results with those of the Canadian study, the only difference appeared to be the percentage of patients who completed the planned courses of chemotherapy in the early treatment arm (69% versus 83%, p = 0.003). Outcomes did not differ significantly in the late treatment arms.

Dr. Hackshaw and his associates reviewed outcomes of eight trials that compared early to late radiotherapy. The only noticeable difference between groups pertained to administration of all planned chemotherapy.

The British team concludes that, when combined chemotherapy and radiotherapy is planned, "it is essential to ensure that the delivery of chemotherapy is optimal."