Early Results of RTOG Small-Cell Lung Cancer Trial

Survival and local control rates for limited stage small-celllung cancer patients treated with either once-daily or twice-dailythoracic radiation plus cisplatin (Platinol) and etoposide (VePesid)are substantially better than with previously reported treatmentregimens, preliminary results of RTOG 88-15 indicate.

The 358 eligible patients were randomized to one of two arms ofthe study. In one arm, patients received thoracic irradiationonce a day to a total dose of 45 Gy in 5 weeks.

In the other arm, patients received 1.5 Gy twice daily to a totaldose of 45 Gy in 3 weeks.

All patients underwent the same chemotherapy regimen of four cyclesof cisplatin (60 mg/m² on day one of radiation treatment)and etoposide (120 mg/m² on days one, two, and three). Thisregimen was repeated at 21-day intervals.

Patients with complete response underwent prophylactic cranialirradiation (25 Gy given in 10 fractions over 2 weeks).

The median survival for patients treated twice a day with radiationwas 20.3 months, said Dr. Wally Curran, an author of the study.It was 18.6 months for patients treated once a day, he said. Thatcompares to about 14 months for patients who undergo standardtreatment. The local failure rate was 61% for patients treateddaily, and 48% for those treated twice daily.

According to Dr. Curran, 15% of patients treated daily had grade3 or worse toxicities, compared with 30% for those treated twicedaily.

"Because we observed better local control and survival rates,RTOG is continuing to pursue twice-daily treatment as a schedulefor limited stage small-cell lung cancer patients," saidDr. Curran. RTOG has two limited stage small-cell lung cancertrials open: RTOG 93-07 and RTOG 93-12.

RTOG 88-15 was an intergroup trial, coordinated by the EasternCooperative Oncology Group. RTOG contributed about one-third ofthe patients to the study.

The results of RTOG 88-15 were presented at the recent annualmeeting of the American Society for Therapeutic Radiology andOncology.