Time and sequence of chemotherapy and radiotherapy in the treatment of lung cancer:observation of 94 limited small cell lung cancer

Objective To assess the importance of the timing and sequencing of chemotherapy and radiotherapy in the combined chemoradiation therapy of locally limited small cell lung cancer.Methods Ninety four eligible patients with limited small cell lung cancer were randomly divided into two groups according to the timing and sequencing of chemotherapy and radiotherapy:(1) Sequential group:six courses of chemotherapy were given first and followed by a full course of radiation therapy in 46 cases. (2) Alternating group:radiation therapy started 3 days after the first cycle of chemotherapy in 48 cases; chemotherapy was given intermittently every 3 to 4 weeks as in conventional chemotherapy. Chemotherapy regimen:Cisplatin 20 mg/m 2 d l 5 and Etoposide 100 mg/m 2 d l 3. Locoregional radiotherapy consisted fo 50?Gy in 25 fractions over 5 weeks using cobalt 60. Results With a follow up of 24 months,66.7% had a complete response in the alternating group as compared with 58.7% in the sequential group (P0.05). The 2 year survival rate was 43.7% in the alternating group as compared with 23.9% in the sequential group. There was a statistically significant difference (P0.05).Conclusions These results suggest that early administration of locoregional radiotherapy may improve the survival.Alternating etoposide cisplatin chemotherapy and locoregional radiotherapy is the method of choice in the combined treatment for locally limited small cell lung cancer.