Combined modality treatment of small-cell bronchial carcinoma
1
161 before irradiation, and after 2 hours the medium was changed. Irradiation was given as a single dose in air. The effect on sur- vival was recorded according to a growth re- tardation method, which was considered most suitable due to the low cloning efficiency of this cell line. The results demonstrate that bleomycin in a dose of 0.i resp 0.01 ug/ml together with irradiation in the dose level of 6 Gy and higher exerts a greater effect on sur- vival than irradiation alone. Thus Bleomy- cin seems to cut off the very large shoul- der in the dose survival diagram, that cha~ racterizes this cell line and makes repair of otherwise subletal damages impossible. However from our in vitro results it is hard to explain the surprisingly good effect found in the clinical study mentio- ned above, since we found no synergism i__nn vitro when only 2 Gy, used in the clinical study mentioned above, was administered. Further studies are needed to elucidate a possible synergistic effect also in the low dose range. Ifosfamide, Mitomycin C and Radiotherapy in Non Small C~II Lung Cancer (NSCLC). Chetiyawardana , A.D., Cullen, M.H., Joshi ~, R.C., Stuart, N.S., Woodroffe, C.M. 1. De- partment of Radiotherapy and Oncology, Queen Elizabeth Hospital, Birmingham. 2. Manor Hospital, Walsall. Ifosfamide and Mitomycin C are 2 of the more active single agents in NSCLC. This study evaluates the 2 drugs in combination followed by local radiotherapy. Twenty-five ambulatory patients with in- operable non small cell lung ~ancer were treated with ifosfamide 5 g/m- as a 24 hour infusion with the concurrent administra- tion of Mesna (160% of2the ifosfamide dose) and Mitomycin C 6 mg/m given as an intra- venous bolus injection on the second day. The mean age is 59 years. All but one patient had squamous cell histology. Fif- teen patients had limited stage disease and 9 had extensive disease. Twenty-three patients are assessable for response to chemotherapy: 8 achieving PR and one CR (verified bronchoscopically). The overall response rate is thus 39%. All but one re- sponse (a PR) were in LD patients. Seventeen patients including the 9 re- sponders received thoracic irradiation (30 Gy in 8 fractions over l0 days) having completed chemotherapy. One PR was conver- ted to a radiological CR. Fifty-five percent of all patients are alive at one year. There has been one death among the 9 responders (d 200) and 8 among 14 non-responders (d 48 - 294). All patients suffered chemotherapy in- duced alopecia but there were no treatment modifications due to my~losuppression, h~t~ morrhagic cystitis or other toxicity. Nausea and vomiting have been troublesome necessita- ting in-patient stay for 3-4 days. There has been one treatment related death. Ifosfamide and Mitomycin C is an active com- bination in limited stage squamous cell lung cancer. Combined Modality Treatment of Small-Cell Bron- chial Carcinoma. Karrer, K. for the International Society of Chemotherapy (ISC)-SmalI-Cell Lung Cancer Stu- dy Group. Institute for Epidemiology of Neo- plasms, University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria. In 1979 a randomized cooperative trial was activated, comparing new sequential intermit- tent polychemotherapies (sq.CT) of 3 different alternating drug combinations given 12 x inter- mittently within 1 year after surgery with a chemotherapy (CT) of 1 combination of 4 drugs given 13 x intermittently within 3 years after surgery. Observations on 25 patients at 9 different cooperating surgical departments showed that sq.CT is applicable, no unexpected side effects occurred. The life table curves calculated per 1.7.1985 indicate the improvement of the sur- vival rate 4 years after surgery for cure of patients receiving sq.CT compared with the survival rate of 31 patients receiving CT af- ter surgery. Following the discussions at the 13th In- ternational Congress of Chemotherapy 1983 in Vienna, a new protocol was activated by a fur- ther enlarged cooperative ISC-SmalI-Cell Lung Cancer Study Group in October 1984. This pro- tocol for a 2-arm randomized cooperative trial for patients operated for cure for pT.,_N_M_ • ~ 21.).U small-cell lung cancer is comparlng a comDlnea chemotherapy 1 as used in ongoing large coope- rative trials in North-America and Europe with the sequential chemotherapy 2 as used before and described above. Results from the trial 1979-1984 and the ISC-trial are discussed in detail. 3 blonths Chemotherapy and Thoracic Radiothe- rap), For Small Cell Lung Cancer (SCLC). Carroll, K.B., Thatcher, N., Barber, P.V., Stout, R. CRC Dept. of Medical Oncology, Dept of Radiotherapy, Christie Hospital & Wythen- shawe Hospital, Manchester, U.K. A short 3 month but intensive treatment regimen for SCLC was assessed in 70 patients. 55 patients had inoperable but limited stage disease, 15 other patients had contra-lateral neck nodes, pleural effusions and marrow in- volvement. 52% of the total patient group had elevated hepatic enzymes but no scan evidence of metastases. 3 courses at93 week intervals of Cyclophos- 9 phamide 2.5 g/m ", day 1 agd Etoposide 120 mg/m- i.v. days 1 & 2, 240 mg/m- orally day 3 were given, followed by Methotrexate (MTX) i00 mg/m 2
Transcript of Combined modality treatment of small-cell bronchial carcinoma
161
before irradiation, and after 2 hours the medium was changed. Irradiation was given
as a single dose in air. The effect on sur-
vival was recorded according to a growth re- tardation method, which was considered most suitable due to the low cloning efficiency
of this cell line. The results demonstrate that bleomycin
in a dose of 0.i resp 0.01 ug/ml together with irradiation in the dose level of 6 Gy and higher exerts a greater effect on sur- vival than irradiation alone. Thus Bleomy- cin seems to cut off the very large shoul- der in the dose survival diagram, that cha~ racterizes this cell line and makes repair of otherwise subletal damages impossible.
However from our in vitro results it is hard to explain the surprisingly good effect found in the clinical study mentio- ned above, since we found no synergism i__nn vitro when only 2 Gy, used in the clinical study mentioned above, was administered. Further studies are needed to elucidate a possible synergistic effect also in the low dose range.
Ifosfamide, Mitomycin C and Radiotherapy in Non Small C~II Lung Cancer (NSCLC). Chetiyawardana , A.D., Cullen, M.H., Joshi ~, R.C., Stuart, N.S., Woodroffe, C.M. 1. De- partment of Radiotherapy and Oncology, Queen Elizabeth Hospital, Birmingham. 2. Manor Hospital, Walsall.
Ifosfamide and Mitomycin C are 2 of the more active single agents in NSCLC. This study evaluates the 2 drugs in combination
followed by local radiotherapy. Twenty-five ambulatory patients with in-
operable non small cell lung ~ancer were treated with ifosfamide 5 g/m- as a 24 hour infusion with the concurrent administra- tion of Mesna (160% of2the ifosfamide dose) and Mitomycin C 6 mg/m given as an intra- venous bolus injection on the second day.
The mean age is 59 years. All but one patient had squamous cell histology. Fif- teen patients had limited stage disease and 9 had extensive disease. Twenty-three patients are assessable for response to chemotherapy: 8 achieving PR and one CR (verified bronchoscopically). The overall response rate is thus 39%. All but one re- sponse (a PR) were in LD patients.
Seventeen patients including the 9 re- sponders received thoracic irradiation (30 Gy in 8 fractions over l0 days) having completed chemotherapy. One PR was conver-
ted to a radiological CR. Fifty-five percent of all patients are
alive at one year. There has been one death among the 9 responders (d 200) and 8 among 14 non-responders (d 48 - 294).
All patients suffered chemotherapy in- duced alopecia but there were no treatment
modifications due to my~losuppression, h~t~
morrhagic cystitis or other toxicity. Nausea and vomiting have been troublesome necessita- ting in-patient stay for 3-4 days. There has
been one treatment related death. Ifosfamide and Mitomycin C is an active com-
bination in limited stage squamous cell lung cancer.
Combined Modality Treatment of Small-Cell Bron- chial Carcinoma. Karrer, K. for the International Society of Chemotherapy (ISC)-SmalI-Cell Lung Cancer Stu- dy Group. Institute for Epidemiology of Neo- plasms, University of Vienna, Borschkegasse 8a, A-1090 Vienna, Austria.
In 1979 a randomized cooperative trial was activated, comparing new sequential intermit- tent polychemotherapies (sq.CT) of 3 different alternating drug combinations given 12 x inter- mittently within 1 year after surgery with a chemotherapy (CT) of 1 combination of 4 drugs given 13 x intermittently within 3 years after surgery.
Observations on 25 patients at 9 different cooperating surgical departments showed that sq.CT is applicable, no unexpected side effects occurred. The life table curves calculated per 1.7.1985 indicate the improvement of the sur- vival rate 4 years after surgery for cure of patients receiving sq.CT compared with the survival rate of 31 patients receiving CT af- ter surgery.
Following the discussions at the 13th In- ternational Congress of Chemotherapy 1983 in Vienna, a new protocol was activated by a fur- ther enlarged cooperative ISC-SmalI-Cell Lung Cancer Study Group in October 1984. This pro- tocol for a 2-arm randomized cooperative trial for patients operated for cure for pT.,_N_M_
• ~ 2 1 . ) . U small-cell lung cancer is comparlng a comDlnea chemotherapy 1 as used in ongoing large coope- rative trials in North-America and Europe with the sequential chemotherapy 2 as used before and described above.
Results from the trial 1979-1984 and the ISC-trial are discussed in detail.
3 blonths Chemotherapy and Thoracic Radiothe- rap), For Small Cell Lung Cancer (SCLC). Carroll, K.B., Thatcher, N., Barber, P.V., Stout, R. CRC Dept. of Medical Oncology, Dept of Radiotherapy, Christie Hospital & Wythen- shawe Hospital, Manchester, U.K.
A short 3 month but intensive treatment regimen for SCLC was assessed in 70 patients. 55 patients had inoperable but limited stage disease, 15 other patients had contra-lateral neck nodes, pleural effusions and marrow in- volvement. 52% of the total patient group had elevated hepatic enzymes but no scan evidence
of metastases. 3 courses at93 week intervals of Cyclophos- 9
phamide 2.5 g/m ", day 1 agd Etoposide 120 mg/m- i.v. days 1 & 2, 240 mg/m- orally day 3 were
given, followed by Methotrexate (MTX) i00 mg/m 2
