Combined Modality Therapy for Limited Small Cell Lung Cancer
Combined modality therapy for limited small cell lung cancer (SCLC) is indicated for local control. Chemotherapy by itself produces excellent responses but an unacceptably high rate of local failure. Small cell lung cancer is exquisitely responsive to a variety of chemotherapeutics and to radiation therapy. The problem with unimodal therapy, i.e., radiotherapy or chemotherapy, is that each modality by itself is inadequate. Waiting too long to use radiotherapy may allow resistant subclones to develop. Once resistant cells leave the local site and colonise distant sites, the patient is doomed. Radiotherapy cannot control occult distant SCLC. However, used too intensively or too early, it may prohibit the use of full doses of chemotherapy needed to control the clinically occult distant disease. Although debate continues, there is an established role for thoracic radiotherapy in limited disease, but use of radiotherapy for chest or other sites of disease in extensive small cell lung cancer is not established. There are 3 general methods of integrating chemotherapy with radiation treatment: 1) sequential therapy, 2) alternating therapy and 3) concurrent therapy. The beneficial and the toxic effects of combined modality therapy may be strongly dependent on the timing. The intrinsic toxicities of the chemotherapy as well as the volume, total and daily dose of thoracic radiotherapy may also influence both toxicity and disease control.
KeywordsSmall Cell Lung Cancer Variant Histology Prophylactic Cranial Irradiation Thoracic Radiotherapy Combine Modality Therapy
Unable to display preview. Download preview PDF.
- 3.Creech R, Richter M, Finkelstein for the ECOG: Combination chemotherapy with or without consolidation radiation therapy (RT) for regional small cell carcinoma of the lung. Proc ASCO 1988 (7):756.Google Scholar
- 5.Arriagada R, Le Chevalier T, Ruffie P, Baldeyrou P, De Cremoux H, Martin M, Chomy P, Cerrina ML, Pellae-Cosset B, Tarayre M, Sancho-Gamier H, The GROP and the French Cancer Center’s Lung Group: Alternating radiotherapy and chemotherapy in 173 consecutive patients with limited small cell lung carcinoma. Int J Radiation Oncol Biol Phys 1990 (19):1135–1138.CrossRefGoogle Scholar
- 6.Perez CA, Einhorn L, Oldham RK, Greco FA, Cohen HJ, Silberman H, Krauss S, Hornback N, Comas F, Omura G, Salter M, Keller JW, McLaren J, Kellermeyer R, Storaasli J, Birch R, Dandy M for the Southeastern cancer study group: Randomized trial of radiotherapy to-the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report. J Clin Oncol 1984 2(11):1200–1208.PubMedGoogle Scholar
- 8.Bunn PA, Jr. Lichter A, Makuch RW, Cohen MH, Veach ST, Matthews MJ, Anderson AJ, Edison M, Glatstein E, Minna JD and Idhe DC: Chemotherapy alone or chemotherapy with chest radiation therapy in limited stage small cell lung cancer: a prospective randomized trial. Ann Intern Med 1987 (106):655–662.PubMedGoogle Scholar
- 11.Ihde DC, Grayson J, Woods E, Gazdar AF, Edison M, Lesar M, Linnoila Rl, Minna JD, Glatstein E and Johnson BE: Twice daily chest irradiation as an adjuvant to etoposide/cisplatin therapy of limited stage small cell lung cancer. In: Salmon SE (ed) Adjuvant Therapy of Cancer VI. WB Saunders, Philadelphia 1990 (III):162–165.Google Scholar
- 12.Turrisi III, AT, Wagner H, Glover D, Mason B, Oken M and Bonomi P: Limited small cell lung cancer (LSCLC): Concurrent BID thoracic radiotherapy (TRT) with Platinum-Etoposide (PE): An ECOG study. Proc ASCO 1990 (9):887.Google Scholar
- 13.Turrisi III, AT, Glover DJ, Mason B and Tester W: Prophylactic cranial irradiation (PCI) after chemotherapy as part of a combined modality platinum (DDP) — Etoposide (VP-16) and twice-daily chest radiotherapy (BID-TRT) for limited small cell lung cancer (LSCLC). Proc ASCO 1989 (8):954.Google Scholar
- 14.Frytak S, Shaw E, Eagan R, Creagan ET, Richardson R, Jett J, Foote R, Colon-Otero G, Buskirk S, Marschke R, Fitch T, Grado R and Themeau T: Accelerated hyperfractionated splitcourse thoracic radiotherapy (AHSCTRT) and infusion cisplatin based chemotherapy (CT) for small cell ung cancer (SCLC). Proc ASCO 1990 (9):906.Google Scholar
- 15.Frytak S, Earnest F, O’Neill BP, Lee RE, Creagan ET and Trautman JC: Magnetic resonance imaging for neurotoxicity in long-term survivors of carcinoma. Mayo Clinic Proc 1985 (60):803–812.Google Scholar
- 16.Turrisi III, AT, Glover DJ, Peitra G and Goldwin J: Variant histology limited small cell lung cancer: A poor prognostic indicator. Proc Am Assoc Cancer Research 1989 (30):1079.Google Scholar