Twice Daily Radiation Therapy Plus Concurrent Chemotherapy for Limited-Stage Small Cell Lung Cancer

Purpose: A rospective study was performed to evaluate the efficiency and feasibility of twice daily radiation therapy plus concurrent chemotherapy for limited-stage small cell lung cancer in terms of treatment response, survival, patterns of failure, and acute toxicities. Materials and Methods: Between February 1993 and Octber 2002, 76 patients of histologically proven limited-stage small cell lung cancer (LS-SCLC) were treated with twice daily radiation therapy and concurrent chemotherapy. Male was in 84% (64/76), and median age was 57 year (range, 32 similar to 75 years). thoracic radiation therapy consisted of 120 or 150 cGy per fraction, twice a day at least 6 hours apart, 5 days a week. Median total dose was 50.4 Gy (range, 45 similar to 51 Gy). Concurrent chemotherapy consisted of CAV (cytoxan 1000 mg/m(2), adriamycin 40 mg/m(2,) vincristine 1 mg/m(2)) alternating with PE (cisolatin 60 mg/m(2), etoposide 100 mg/m(2)) or PE alone, every 3 weeks. The median cycle of chemotherapy was six (range, 1 similar to 9 cyde). Prophylactic cranial irradiation (PCI) was recommended to the patients who achieved a complete response (CR). PCI scheme was 25 Gy/ 10 fractions. Median Follow up was 18 months (range, 1 similar to 136 months). Results: Overall response rate was 86%; complete response in 39 (52%) and partial response in 26 (34%) patients. The median overall survival was 23 months. One, two, and three year overall survival rate was 72%, 50% and 30% respectively. In univariate analysis, the treatment response was revealed as a significant favorable prognostic factor for survival (p < 0.001). Grade 3 or worse acute toxicities were leukopenia in 46 (61%), anemia in 5 (6%), thrombocytopenia in 10 (13%) , esophagitis in 5 (6%) , and pulrnonary toxicity in 2(2%) patients. Of 73 evaluable patients, 40 (55%) patients subsequently had disease progression. The most frequent first site of distant metastasis was brain. Conclusion: Twice daily radiation therapy plus concurrent chemotherapy produced favorable response and survival for LS-SCLC patients with tolerable toxicities. To improve the treatment response, which proved as a significant prognostic factor for survival, there should be further investigation about fractionation scheme, chemotherapy regimens and compatible and compatible chemoradiotherapy scheduale.