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Japanese Journal of Clinical Oncology 33:620-625 (2003)
© 2003 Foundation for Promotion of Cancer Research

Early Concurrent Chemoradiotherapy with Prolonged Oral Etoposide and Cisplatin for Limited-stage Small-cell Lung Cancer

Se-Hoon Lee1, Yong Chan Ahn2, Ho Joong Kim3, Do Hoon Lim2, Soon Il Lee1, Eunmi Nam1, Se Hoon Park1, Jinny Park1, Kyung-Eun Lee1, Joon Oh Park1, Kihyun Kim1, Won Seog Kim1, Chul Won Jung1, Young-Hyuck Im1, Won Ki Kang1, Mark H. Lee1 and Keunchil Park1,+

1 Division of Hematology and Oncology, Department of Medicine, 2 Department of Radiation Oncology and 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Background: Combined chemoradiotherapy (CRT) is the standard treatment modality for limited-stage small-cell lung cancer (LSCLC), but the optimal timing of radiation is controversial. Prolonged oral etoposide has the advantage of prolonged exposure, which possibly leads to improved clinical outcome. We conducted a phase II trial of early concurrent CRT, starting from the very beginning of the first cycle of chemotherapy for previously untreated LSCLC.

Methods: Chemotherapy was given for six cycles, each consisting of oral etoposide (50 mg/m2 daily from day 1 to 14) and intravenous cisplatin (75 mg/m2 on day 1), every 3 weeks. Thoracic radiation therapy was given from day 1 of the first cycle of chemotherapy, administered at 2.0 Gy in 22 daily fractions to a total dose of 44 Gy.

Results: Forty-four patients were enrolled. The median age was 60 years (range, 42–77 years), including 15 patients (34%) over 65 years-of-age. We observed a complete response rate of 52% (95% CI, 37–67%), and an overall response rate of 88% in an intent-to-treat (ITT) analysis. Median overall survival was 14.9 months (95% CI, 11.4–18.3 months) and the median time to progression was 10.8 months (95% CI, 9.3–12.4 months) for the ITT population. In 220 cycles, grade 3–4 neutropenia was observed in 48% of cycles and grade 3–4 thrombocytopenia in 30% of cycles. Neutropenic fever was observed in 18 patients (41%).

Conclusions: Early concurrent CRT, starting from the very beginning of the first cycle of chemotherapy with prolonged oral etoposide and cisplatin failed to show any improvement in survival compared with other CRT regimens.

+ For reprints and all correspondence: Keunchil Park, Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. E-mail: kpark{at}smc.samsung.co.kr


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