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Turkish Journal of Cancer
1992, Volume 22, Number 3, Page(s) 112-120
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The effect of radiation therapy in limited small cell lung cancer
Keywords: radiotherapy, combined modality, multi-agent chemotherapy, lung cancer, small cell carcinoma
Thirty-nine cases with small cell lung carcinoma (SCLC) treated with radiation therapy and/or chemotherapy were analyzed retrospectively. All patients had limited disease. Mean age of the cases was 58 years. Thirty-six patients were male (92%). The most commonly seen initial symptoms were cough (72%), pleural pain (44%), dyspnea (36%), hemoptysis (28%) and fatigue (28%). Diagnosis was made by sputum cytology in 16 cases (41%), and by bronchoscopy in 12 cases (31%). Seventeen cases were treated with chemotherapy alone and nineteen with combined modality. Radiation therapy was administered either concomitantly with multi-agent chemotherapy (concurrent), after multi-agent chemotherapy (post-chemotherapy), or in between the cycles of multi-agent chemotherapy. These patients also received one of the combinations of Vp16-P, CAV, Vp16-PCc, CVCc, AVBMVp16 or Vp16-P/CAV. Patients in the chemotherapy alone group received Vp16-P or CAV combinations, in this group seven patients had complete response (CR 41%) and six had partial response (PR 35%). In the combined modality group, the CR rate was 63% and the PR rate 26% (p=0.11). There was no correlation between the CR rate and total radiation dose or radiation dose per fraction (p=0.33 and 0.28). No correlation was found between the multi-agent chemotherapy regimens and the CR rate (p=0.25). Median survival in the chemotherapy group was 7.5 months and 9.0 months in the combined modality treatment group. Overall complication rate in the chemotherapy alone group was 12% (2/17) while it was 32% (6/19) in the combined modality group (p=0.12). Distant metastasis rates were 29% and 21%, respectively. It is concluded that the addition of radiation therapy to multi-agent chemotherapy may be of some benefit in terms of complete response rates without any significant increase in complications, but well designed prospective, randomized, controlled studies are needed to assess the role of radiation therapy in terms of local control, overall survival and optimal treatment schedules.
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