INNOVATIONS IN MULTIMODALITY THERAPY FOR LUNG-CANCER - COMBINED MODALITY MANAGEMENT OF LIMITED SMALL-CELL LUNG-CANCER

Recent approaches to the treatment of limited small-cell lung cancer have combined local radiotherapy and systemic chemotherapy in an attempt to improve local control and inhibit distant metastases. Local control is a key indicator of the efficacy of radiotherapy administration in combined-modality regimens. However, even in combined-modality trials using high total radiotherapy doses, local failure rates have ranged from 30 to 50 percent. The components of radiotherapy administration-including dose, volume, fractionation, integration with chemotherapy (concurrent, alternating, or sequential), and timing (early or late administration)-are also important considerations. Hyperfractionation, or the administration of small fractions of radiation more than once daily (usually twice), and accelerated hyperfactionation, or the administration of three fourths of the standard radiation dose two to three times daily, have emerged as important concepts in radiotherapy. Although the optimal chemotherapy regimen for combined-modality treatment has not yet been established, use of cisplatin and etoposide combinations, which do not promote pulmonary, cardiac, or esophageal toxicity, have been particularly appropriate in patients with small-cell lung cancer.