Short duration combination chemotherapy inthe treatment ofsmall cell lung cancer

Ninety five patients (57withlimited disease and38withextensive disease) with pre- viously untreated small cell lung cancerwere entered into a study ofshort duration combination chemotherapy withintravenous cyclophosphamide (750mg/m2) on day1,adriamycin (40mg/m2) on day1,andetoposide VP-16(100mg/m2) on days1,2,and3,withtheaddition on day10of methotrexate 50mg/M2withfolinic acid rescueandvincristine 2mg. Thetreatment was repeated on day22andonlythree courseswere given. Nomaintenance chemotherapy was given, though patients with acomplete responsereceived radiotherapy (30-40 Gy(3000-4000 rads)) tothepri- mary site inmostcases.Forty nine patients (86%)withlimited disease achieved a response,with26 (46%)complete remissions. Twentyfive patients (66%)withextensive disease hada response,but onlyeight (21%)hadacomplete response.Actuarial survival analysis forthewholepatient popu- lation showed a median survival of13months forpatients withlimited disease andsevenmonths forthose withextensive disease. Themedian survival was 14months forthose patients withlimited disease who achieved a complete response,butonly10monthsfornon-responders. Myelosuppression was themajorexpression oftoxicity. There were three deaths related to treatment andsevenpatients hadfebrile episodes during neutropenia thatrequired antibiotics. Mucositis, which was usually mild, occurred in49%ofpatients. Theprimary site was themainsite ofinitial relapse in56%ofthepatients whorelapsed. Amongpatients withlimited disease who achieved acomplete response,relapses attheprimary site wereless common inthose whoreceived radiotherapy (five outof12)thaninthose whodidnot(all eight). Theresults indicate that this short duration chemotherapy insmall cell lung cancergives responserates andthepotential forlong term survival similar tothose obtained inother series while allowing patients themaximumtimefree fromtreatment.