The role of chest irradiation in limited small cell carcinoma of the lung treated with combination chemotherapy

Abstract

Between October 1974 and December 1980, 123 patients with limited small cell carcinoma were treated in the Indiana University Medical Center Department of Radiation Oncology. Of these, 115 were treated with preplanned combined modality therapy using irradiation and polychemotherapy (Adriamycin, Cytoxan and Oncovin). All patients received whole brain prophylactic irradiation and were followed a minimum of 2 years. Sixty-six patients were given chest irradiation with all but two receiving 3500–40110 rad while 49 did not receive this treatment. Sixty-five percent of those patients receiving chest irradiation had a complete response to therapy, as opposed to 33% who did not ( p < 0.02). The median and overall survivals were significantly different between the 2 groups (423 days vs. 307 days). The overall and long-term survivals were higher in those receiving chest irradiation or resective surgery. Serial chest X rays (and port films, where applicable) were reviewed on all patients to determine sites of failure. Of relapsing patients who did not receive chest irradiation, failure always included the primary site. Of those who had chest irradiation, only 15% of evaluable patients did not relapse in the chest prior to death. This study demonstrates an increased response rate, median survival, and overall survival in patients receiving chest irradiation. The high rate of relapse in the chest suggests the need for more effective control of the primary. This may be accomplished by increasing the dose of chest irradiation or surgical removal when feasible.