A cooperative national clinical trial has produced the first major treatment advance in years for small-cell lung cancer. The study, which was published in the February 1999 issue of the New England Journal of Medicine, used two treatments of radiation daily, combined with chemotherapy, compared to the usual practice of delivering one radiation dose per day. Specifically, the protocol covered small-cell lung cancer limited to one-half of the chest area.
Cooperating in the trial were the Radiation Therapy Oncology Group (RTOG), the Eastern Cooperative Oncology Group (ECOG), and the Southwest Oncology Group (SWOG).
“Radiation to the chest confined to one lung and adjacent lymphatics improves survival,” according to lead author Andrew T. Turrisi, III, md. “But there has been lack of agreement on the best ways to integrate thoracic radiotherapy and chemotherapy for this form of lung cancer.” Dr. Turrisi is professor and chairman of the Department of Radiation Oncology, Medical University of South Carolina, Charleston.
Improved Survival
He explained that the cooperative trial involved 417 patients with limited, small-cell lung cancer. All received chemotherapy with cisplatin(Drug information on cisplatin) (Platinol) plus etoposide(Drug information on etoposide), but some received radiation once a day, while others received it twice a day. The radiation dose was identical.
The patients who received two radiation treatments daily plus chemotherapy had overall survival rates of 47% at 2 years and 26% at 5 years. Those receiving one radiotherapy treatment daily had rates of 41% and 16% for the comparable time periods.
The overall survival rates for the two groups of patients were 44% at 2 years and 23% at 5 years, he added. “This represents a considerable improvement in survival rates over previous results in patients with limited, small-cell lung cancer.”
For further information about RTOG clinical trials, call Nancy Smith at 215-574-3205.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
