Neutron radiation therapy for unresectable non-small-cell carcinoma of the lung
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62 Radiotherapy Neutron radiation therapy for unresectable non-small-cell carci- noma of the lung Stcwrut G, Griffin TW, Grlffm BR ct al. Deparlmeni of Radialion Oncology, Universir); of Washrngton, University Cancer Center, Se- attle, WA 98195. Am J Clin Oncol, Cancer Clin Trials 1989:12:290-4. Over 200 patients have been cntcrcd in five studies investigating the use of fast neutron radiation therapy in the trcatmcnt of non-small-cell carcmomas of the lung since 1983. The results of thcsc studies have been inconsistent. Most studlcs dtd not show survival rates or local control advantages over slandard photon radiation therapy. Side cffccts from studies employing mixed photon-neutron treatment plans or clinically oriented, high-energy cyclotrons wcrc seen to be comparable to those of standard courses of radiation therapy, rcprescnting a consid- erablc improvcmcnt over those studies utilizing low-energy cyclotrons for a full course of radiation therapy, which resulted in unacceptably high comphcauon rates. A new phase 111 study utih/mg high-energy lsoccntllc neutron beams has been dcsigncd and implcmcntcd, and over 100 patients have been cntcrcd to date. The current status of fast neutron radiatlon therapy in the trcatmcnt of non-small-cell lung cancer is reviewed. Carboplatin, ifosfamide and etoposide with mid-course vincristine and tboracic radiotherapy for ‘limite’ stage small cell carcinoma of the bronchus Thatcher N, Lmd M, Stout R et al. CRC Depnrtment of Medical Oncology, Chrisfie Hospttal. Manchester M20 9BX. Br J Cancer 1989; 60:98-101. Forty-two patients with small cell lung cancer were treated with a combination of carboplatin, ifosfamide and etoposide. Vincristine was givenonday 14ofeachcourse,thecoursesbeingrepeatedevery28days for a maximum of six. Thoracic radiotherapy was given 4 weeks after the lastcourseofchemotherapy butnoprophylacticcranialradiotherapy was administered. Thirty patients had clinically limited stage disease, the remaining patients havmg contralateral neck lymphadenopathy and/ or pleural effusions. Elevated enzyme levels (alkaline phosphatase, LDH, ALT, GGT) were noted in 69% of patients. Twenty-four patients (57%) achieved a complete response (CR) when assessed one month after the end of treatment. A further 21% of patients had a partial response (PR). Median duration of CR was 14 months and of PR 8 months. Cerebral metistases were the sole site of relapse m 13% of the CR patients. Myelosuppression was severe with a median nadir of neutropcnia of 0.2 x lo9 cells I ‘ . However. 74% of the patient group received all six courses of chemotherapy and only 16courses (7%) were delayed because of toxicity. There were three deaths associated with treatment-related neutropenia. The median survival of the total group was 14 months, withanactuar~al2ycarsurvivalof37%aandaminimum follow-up of 18 months. Combined treatment modalities Development of postoperative intrathoracic chemo-thermotherapy for lung cancer with objective of improving local cure Kodama K, Doi 0, Tatsuta M, Kurlyama K, Tatcishi R. Department of Thoracic Surgery. The Center for Adult Diseases, Higashinari-ku, Osaka 537. Cancer 1989;64: 1422-E. From April 1985 through March 1988,24 lung cancer patients with carcinomatous pleuritis were treated with a new combined treatment modality consisting of pulmonary resection and postopcrativc intratho- racic chemo-thermotherapy (PICT). They consisted of 15 male patients and nine female patients. A majority of the patients (79%) had aden- ocarcinoma. The PICT was started 10 to 14 days after the operation. Immediately after a bolus intrathoracic Injection of clsplatm (CDDP) SO-100 mg, thermotherapy was carried out using 13.56-MHz or 8.00. MHz radiofrequency waves for 60 minutes. The periplcural tempera- ture was precisely monitored in 20 patients. The temperature was successfully maintained above 42°C for 40 minutes in each of two or three treatment courses in 13 patients, with no complications. However, in the other seven patients the therapy resulted in incomplctc treatment because of development of a side effect. Cytologic examination of the pleural effusion, which was performed after the completion of PICT, gave a negative result in 16 of 20 patients examined. The median follow-up period was 16 months. Local relapse was recogmzed in only three cases who received incomplete treatment or in whom no tempera- turc measurement was performed. The overall survival of the treated patients (n = 24) was significantly prolonged in comparison with a historical control group treated by surgery only (n = 17) or exploratory thoracotomy (n = 11). Of those 17 patients treated by surgery only, ten patients (59%) died of local relapse. These results suggest that this new treatment modality consisting of pulmonary resection and PICT is useful for the treatment of lung cancer patients with carcmomatous pleuritls, especially in the light of improved local control. Neoadjuvant vindesine, etoposide, and cisplatin for locally ad- vanced non-small cell lung cancer. Final report of a phase 2 study Vokes EE, Bitran JD, Hoffman PC, Ferguson MK, Weichselbaum RR, Golomb HM. Joint Section of IIematologyiOncology. Department of Radiation Oncology, University of Chicago, Chicago, IL 60637. Chest 1989;96:110-13. We treated 27 patients with regionally advanced non-small-cell lung cancer (NSCLC) with two cycles of neoadjuvant chemotherapy with etoposide, vindesine, and cisplatin. Twenty-three patients were evalu- able for response; 13 had a partial response while ten patients had stable disease or disease progression. Subsequent local therapy consisted of surgery followed by radiotherapy in four patients and of radiotherapy alone in 14 patients. Five patients did not receive local therapy. At completion of local therapy, seven patients were considered free of disease including all four who had undergone surgery. Median time to disease progression for the 13 patients who had a partial response to neoadjuvantchemotherapy waseightmonths(threetoSl+months).The median survival for all patients registered on study was eight months (three days to 53+ months). Chemotherapy induced toxicities included moderate myelosuppression, nausea and vomiting in all patients, and occasional ototoxicity, neurotoxicity, and wasting syndrome. One patient died of intracerebral hemorrhage due to thrombocytopenia. This trial shows thatadministrahonof ncoadjuvant chemotherapy topatients with locoregionally advanced NSCLC is feasible and may yield an increased response rate compared to patients with stage IV disease. While no clearly beneficial effect of tbc use of chemotherapy on patient survival is apparent in this study, further studies utilizing neoadjuvant chemotherapy in patients with NSCLC are warranted and should attempt to identify more active combinations of drugs. Intrapleural BCG in postsurgical stage I non-small cell lung cancer Macchiarini P, Mussi A, Angeletti CA. Service of Thoracic Surgery. University of Piss, I-56100 Piss. Anticancer Res 1989;9:391-4. In a randomized trial comparing intrapleural bacillus Calmette- Guerin (BCG) with placebo in postsurgical stage I non-small cell lung cancer, BCG-treated patients (n = 17) showed a non-significant overall improvement of 5-year and median survival and disease-free. interval, but an increased rate of recurrence of cancer compared with control patients (n = 17). Surgical adjuvant therapy of non-small-cell lung cancer Holmes EC. Lung Cancer Study Group, Department of SurgeryiOncol- ogy, UCLA School of Medicine, Los Angeles. CA 90024-I 782. J Surg Oncol 1989;41:SUPPL. 1:26-33.
Transcript of Neutron radiation therapy for unresectable non-small-cell carcinoma of the lung
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Radiotherapy Neutron radiation therapy for unresectable non-small-cell carci- noma of the lung Stcwrut G, Griffin TW, Grlffm BR ct al. Deparlmeni of Radialion Oncology, Universir); of Washrngton, University Cancer Center, Se- attle, WA 98195. Am J Clin Oncol, Cancer Clin Trials 1989:12:290-4.
Over 200 patients have been cntcrcd in five studies investigating the use of fast neutron radiation therapy in the trcatmcnt of non-small-cell carcmomas of the lung since 1983. The results of thcsc studies have been inconsistent. Most studlcs dtd not show survival rates or local control advantages over slandard photon radiation therapy. Side cffccts from studies employing mixed photon-neutron treatment plans or clinically oriented, high-energy cyclotrons wcrc seen to be comparable to those of standard courses of radiation therapy, rcprescnting a consid- erablc improvcmcnt over those studies utilizing low-energy cyclotrons for a full course of radiation therapy, which resulted in unacceptably high comphcauon rates. A new phase 111 study utih/mg high-energy lsoccntllc neutron beams has been dcsigncd and implcmcntcd, and over 100 patients have been cntcrcd to date. The current status of fast neutron radiatlon therapy in the trcatmcnt of non-small-cell lung cancer is reviewed.
Carboplatin, ifosfamide and etoposide with mid-course vincristine and tboracic radiotherapy for ‘limite’ stage small cell carcinoma of the bronchus Thatcher N, Lmd M, Stout R et al. CRC Depnrtment of Medical Oncology, Chrisfie Hospttal. Manchester M20 9BX. Br J Cancer 1989; 60:98-101.
Forty-two patients with small cell lung cancer were treated with a combination of carboplatin, ifosfamide and etoposide. Vincristine was givenonday 14ofeachcourse,thecoursesbeingrepeatedevery28days for a maximum of six. Thoracic radiotherapy was given 4 weeks after the lastcourseofchemotherapy butnoprophylacticcranialradiotherapy was administered. Thirty patients had clinically limited stage disease, the remaining patients havmg contralateral neck lymphadenopathy and/ or pleural effusions. Elevated enzyme levels (alkaline phosphatase, LDH, ALT, GGT) were noted in 69% of patients. Twenty-four patients (57%) achieved a complete response (CR) when assessed one month after the end of treatment. A further 21% of patients had a partial response (PR). Median duration of CR was 14 months and of PR 8 months. Cerebral metistases were the sole site of relapse m 13% of the CR patients. Myelosuppression was severe with a median nadir of neutropcnia of 0.2 x lo9 cells I ‘. However. 74% of the patient group received all six courses of chemotherapy and only 16courses (7%) were delayed because of toxicity. There were three deaths associated with treatment-related neutropenia. The median survival of the total group was 14 months, withanactuar~al2ycarsurvivalof37%aandaminimum follow-up of 18 months.
Combined treatment modalities
Development of postoperative intrathoracic chemo-thermotherapy for lung cancer with objective of improving local cure Kodama K, Doi 0, Tatsuta M, Kurlyama K, Tatcishi R. Department of Thoracic Surgery. The Center for Adult Diseases, Higashinari-ku, Osaka 537. Cancer 1989;64: 1422-E.
From April 1985 through March 1988,24 lung cancer patients with carcinomatous pleuritis were treated with a new combined treatment modality consisting of pulmonary resection and postopcrativc intratho- racic chemo-thermotherapy (PICT). They consisted of 15 male patients and nine female patients. A majority of the patients (79%) had aden- ocarcinoma. The PICT was started 10 to 14 days after the operation. Immediately after a bolus intrathoracic Injection of clsplatm (CDDP)
SO-100 mg, thermotherapy was carried out using 13.56-MHz or 8.00. MHz radiofrequency waves for 60 minutes. The periplcural tempera- ture was precisely monitored in 20 patients. The temperature was successfully maintained above 42°C for 40 minutes in each of two or three treatment courses in 13 patients, with no complications. However, in the other seven patients the therapy resulted in incomplctc treatment because of development of a side effect. Cytologic examination of the pleural effusion, which was performed after the completion of PICT, gave a negative result in 16 of 20 patients examined. The median follow-up period was 16 months. Local relapse was recogmzed in only three cases who received incomplete treatment or in whom no tempera- turc measurement was performed. The overall survival of the treated patients (n = 24) was significantly prolonged in comparison with a historical control group treated by surgery only (n = 17) or exploratory thoracotomy (n = 11). Of those 17 patients treated by surgery only, ten patients (59%) died of local relapse. These results suggest that this new treatment modality consisting of pulmonary resection and PICT is useful for the treatment of lung cancer patients with carcmomatous pleuritls, especially in the light of improved local control.
Neoadjuvant vindesine, etoposide, and cisplatin for locally ad- vanced non-small cell lung cancer. Final report of a phase 2 study Vokes EE, Bitran JD, Hoffman PC, Ferguson MK, Weichselbaum RR, Golomb HM. Joint Section of IIematologyiOncology. Department of Radiation Oncology, University of Chicago, Chicago, IL 60637. Chest 1989;96:110-13.
We treated 27 patients with regionally advanced non-small-cell lung cancer (NSCLC) with two cycles of neoadjuvant chemotherapy with etoposide, vindesine, and cisplatin. Twenty-three patients were evalu- able for response; 13 had a partial response while ten patients had stable disease or disease progression. Subsequent local therapy consisted of surgery followed by radiotherapy in four patients and of radiotherapy alone in 14 patients. Five patients did not receive local therapy. At completion of local therapy, seven patients were considered free of disease including all four who had undergone surgery. Median time to disease progression for the 13 patients who had a partial response to neoadjuvantchemotherapy waseightmonths(threetoSl+months).The median survival for all patients registered on study was eight months (three days to 53+ months). Chemotherapy induced toxicities included moderate myelosuppression, nausea and vomiting in all patients, and occasional ototoxicity, neurotoxicity, and wasting syndrome. One patient died of intracerebral hemorrhage due to thrombocytopenia. This trial shows thatadministrahonof ncoadjuvant chemotherapy to patients with locoregionally advanced NSCLC is feasible and may yield an increased response rate compared to patients with stage IV disease. While no clearly beneficial effect of tbc use of chemotherapy on patient survival is apparent in this study, further studies utilizing neoadjuvant chemotherapy in patients with NSCLC are warranted and should attempt to identify more active combinations of drugs.
Intrapleural BCG in postsurgical stage I non-small cell lung cancer Macchiarini P, Mussi A, Angeletti CA. Service of Thoracic Surgery. University of Piss, I-56100 Piss. Anticancer Res 1989;9:391-4.
In a randomized trial comparing intrapleural bacillus Calmette- Guerin (BCG) with placebo in postsurgical stage I non-small cell lung cancer, BCG-treated patients (n = 17) showed a non-significant overall improvement of 5-year and median survival and disease-free. interval, but an increased rate of recurrence of cancer compared with control patients (n = 17).
Surgical adjuvant therapy of non-small-cell lung cancer Holmes EC. Lung Cancer Study Group, Department of SurgeryiOncol- ogy, UCLA School of Medicine, Los Angeles. CA 90024-I 782. J Surg Oncol 1989;41:SUPPL. 1:26-33.
