The purpose of this study was to evaluate the effect of the timing of thoracic radiotherapy in the combined modality therapy of limited stage small cell lung cancer with respect to local control and survival.
Two hundred and one patients with limited stage small cell lung cancer were treated at Seoul National University Hospital between April 1979 and February 1991. Of these, 112 patients received thoracic radiotherapy following 2 cycles of
cyclophosphamide,
adriamycin and vincristine(CAV) or VP-16, ifosphamide and cisplatin(VIP) alternating CAV schedule(sequential CT/RT) and 89 patients received thoracic radiotherapy concurrently with the 3rd cycle of etoposide and cisplatin(EP) or alternating
EP/CAV
schedule(concurrent CT/RT). Thoracic radiotherapy consisted of 40~45 Gy in 4~5 weeks. All patients received prophylactic cranial irradiation with 25 Gy 10 fractions over 2 weeks.
The over survival at 2 years for all 201 patients was 29.2%, with a median survival of 17 months. The median survival was 16 months for the sequential CT/RT and 18 months for the concurrent CT/RT. the survival rate in the sequential CT/RT
schedule
was
26.1% at 2 years, and 16.2% at 5 years, as compared with 32.5%, and 22.8% at 2 years and 5 years, respectively, in the concurrent CT/RT schedule. However, there was no significant difference between the two schedules(p=0.11). The local control
rates for
alternating EP/CAV regimens with concurrent thoracic radiotherapy was significantly higher than that for other regimens(p=0.003). Seventy-two(48%) patients had local failure as the first site of failure, whereas 39(26%) patients had distant
failure
without local failures. Thirty-eight(26%) patients had local and distant failure.
These results indicate that early, concurrent thoracic radiotherapy with alternating EP/CAV regimens have the improved local control rates and a trend of the better survival in the combined modality treatment of limited stage small cell lung
cancer.
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