Abstracts/Lung Cancer 12 (1995) 113-160 157

Intensive combined-modality therapy in amall cell lung cancer Thatcher N, Lorrigan P, Burt P, Stout R. Departmenr o/Medical Oncology, Christie Hospital, Wbnslow Rd, Manchester M20 9EX Semin Dncol 1994;21:Suppl6:9-22. Combination ifosfamid&arboplatin/etoposide (ICE) chemotherapy and ICe plus mid-cycle vincristine (VICE) are reviewed. Thoracic radiotherapy and prophylactic cranial irradiation given as single fractions in the majority of patients have been intercalated with VICE in the later studies. The patient populations have not been intensively staged with wmputed tomography, etc, but do have reasonable Kamofsky performance status ratings and biochemical screens. A policy of no dose reduction over six courses of VICE chemotherapy has been followed in three consecutive studies of 166 patients. The minimum length of follow-up is 26 months and the 2-year survival rate is 30%. Hematopoietic growth factor support in an attempt to overcome the considerable myelosuppression with VICE therapy is currently being evaluated.

Randomized trial comparing postoperative chemotherapy with viadesiae and cisplatin plus tboracic irradiation with irradiation alone in stage III (N2) non-small cell lung cancer Pisters KMW, Kris MG, Gralla RJ, Hilaris B, McCormack PM Bains MS et al. Thoracic Oncology Sentice, MemorialSloan-Kettering Cancer Cti, 1275 YorkAvenue, New York, NY10021. JSurgOncoll994;56:236- 41. This prospective randomized trial was performed to determine whether postoperative chemotherapy with vi&sine and cisplatin could lengthen time to progression and overall survival in stage III (Tl-3N2MO) non- small cell lung cancer t.NSCLC) patients. Seventy-two patients were entered; 36 were randomized to receive chemotherapy. Patients were stratitied by extent of resection (complete vs. incomplete) and histology (squamous vs. nonsquamous). All had surgery and mediastinal

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had intraoperative ‘*‘I and/or ‘?r implantation. Vmdesine (3 mg/m’) weekly x 5, then every 2 weeks x 8, and cisplatin (120 mg/m*) days 1, 29, 71, 113 were planned for those randomized to chemotherapy. No difference in time to progression (median 9.2 months for radiation + chemotherapy vs. 9.0 months for radiation, P = 0.35) or overall survival (16.3 months for radiation + chemotherapy vs. 19. I months for radiaticn, P = 0.42) was found. Postoperative vindesine and cisplatin did not prolong time to progression or survival in this population of stage III NSCLC.

Role of radiotherapy in combined modality treatment of locally dvwwd non-smalkell lung cancer KubotaK,FurnseK,KawaharaM, KodamaN,YamamotoM,Ogawara M et al. Department of Internal Medicine, Nod. Kinki Cent. Hosp. Chest Dis., 1180 Nagasone-cho. Sakai, Osaka 591. J Clin Oncol 1994;12: 1547-52. Purpose: For patients with locally advanced (stage III) non-small-cell lung cancer (NSCLC), radiotherapy (RT) has been used conventionally for many years. Few prospective trials have determined the role of RT. Recently, chemotherapy (CT) has been shown to produce excellent responses in regionally advanced disease. We therefore conducted a randomized trial using cisplatin (P)-based CT regimens with or without thoracic irradiation. Patients and Metho& We randomly assigned 92 patients with locally advanced NSCLC to receive one of three arms of P-based combination chemotherapy: vindesine (V) plus P, mitomycin (Tvf) plus V plus P, or etoposide Q plus P alternating with V plus M. After two cycles of CT, patients were reevaluated and those with stage III were again randomized to receive RT or not. RT consisted of 50 to 60 Gy in 5 to 6 week, 2 Gy was delivered once daily in conventional

fractions. Results: Sixty-three patients were included in the second randomization. The patients in the CURT group (n = 32) and CT- alone group (n = 3 I) were comparable in terms of age, sex, performance status, histologic features, stage of disease, and induction CT regimen. The median durations of survival were similar for the two groups (46 1 days in CTiRT group and 447 days in CT-alone group). The survival rate in the CURT group was 58% at I year, 36% at 2 years, and 29% at 3 years, as compared with 66%, 9%, and 3% at I, 2, and 3 years, respectively, in the CT-alone group. One patient in the CT/RT group died of pnemnonitis, but there were no CT-related deaths. Conclusion: In locally advanced NSCLC, P-based combination CI followed by chest irradiation significantly increases the nmnber of long-term smvivors as compared with CT alone. RT to bulky disease in the thorax is thus an important part of combined modality therapy, and a necessary part of further studies in locally advanced disease.

Combined trratmeat in superior sulcus tumors Martinez-Monge R, Herreros J, Aristu JJ, Aramendia JM, Azinovic I. Departamento de Oncologia, Clinica Universitaria de Navarra, Pio XII s/n, 31080 Pamplona (Navarra). Am J Clin Oncol Cancer Clin Trials 1994;17:3 17-22. From January 1988 to August 1992,18 patients @ts) with the established diagnosis of non-small cell lung cancer of the superior sulcus have been treated with a multidisciplinary approach, which inchalea l-3 cycles of neoadjuvant chemotherapy (MVP or MCP regimens) followed by simultaneous preoperative chemotherapy and external beam irradiation. Radical surgery plus intraoperative radiotherapy (IORT) was planned 4-5 weeks after the end of the preoperative protocol. Tumor stages were IIIA (9 pts) and IIIB (9 pts). Tumor characteristics included rib and vertebral involvement in 15 and 4 pts, respectively. Fatal toxicity was present in 3 pts (16.6%). Resectability rate was 76.4%. Pathologic tlndings disclosed complete response @TO) in 70.5% of the surgical specimens and viable tumor (pT+) in 29.5%. With a median follow- up of 24+ months (2-52+), 4-year actuarial local control, and overall survival rates are 9 1% and 56.2%, respectively. Four-year actuarial overall survival according to pathologic response was 87.5% for pT0 patients and 20% for pT + patients. We conclude that this regimen promotes a high rate of pT0 as well as better than expected local control and survival rates. The presence of a pTO specimen seems to correlate with the patient outcome.

Superior sulcus tumors: Combined modality Fuller DB, Chambers JS. 2466 FirstAve, San Diego, CA 92101 ANI Thorac surg 1994;57:1133-9. Twenty-four patients with superior s&us tumors were seen between 1955 and 1989. Fiieen of these patients received combined-modality therapy. In 2 patients, this consisted of primary operation followed by postoperative radiotherapy, and, in 13, high-dose conventionally fractionated preoperative radiotherapy (5,500 to 6,475 cGy) followed by en bloc resection. Of the I3 patients who received radiotherapy preoperatively, 7 survived free of disease beyond 5 years and 2 others remained without evidence of disease after a shorter follow-up (greater than 2 years). The long-term survival in the combined-modality patients in this small series is superior to that reported for other patients receiving combined-modality therapy, and the morbidity appears to be within accepted limits despite the aggressive preoperative radiotherapy program. One postoperative death occurred in our only octogenarian but there were no other acute complications. High-dose preoperative radiotherapy using current techniques and fractionation appears to be feasible in conjunction with wntemporarv surgical techniques. We

superior survival rate in this series and may also be applicable in the setting of other locally advanced (stage III) bronchogenic carcinomas.