RadiationOncology ??Biology ??Physics ARS 63rd Annual Meeting 93

The chemotherapeutic agents employed were 2 different drug regimens: Vincristine + cytoxan + adriamycin or cytoxan + methotrexate and CCNU. The 6 month to 5 year survivals in Group C patients treated with 2 forms of RT techniques were comparable with RT plus chemotherapy. Patients receiving chemotherapy alone have a shorter survival rate than those treated with RT alone. In July 1976 a new protocol was started for Stage 111 squamous cel1 carcinoma of the lung in which 22 patients received 5000 rads in 5 weeks and were ran$mized for Funotherapy to receive (a);-ER every 4 weeks and [b) VAC vincfistine 1.4 mg/m I.V. + adriamyc~n 50 mg/m I.V. + Cyclophosphamide 500 mg/m I.V. every 4 weeks, or (c) MER + VAC every 4 months. Median survival among these regimens was not established significantly.

(124) SMALL CELL CARCINOMA OF THE LUNG: RESULTS OF COMBINED MODALITY TREATMENT OF LIMITED STAGE PATIENTS

David J. Harter, M.D.1 David L. Howe, M.D?

James E. Bruckman, M.D.l John R. Feagler, M.D.1

1Bishop Clarkson Memorie1 Hospital, Omaha, Nebraska 2University of Nebraska Medical Center, Omaha, Nebraska

A combined modality regimen for limited stage smal1 cel1 carcinoma of the lung was designed to maximize the frequency and duration of complete remission and to minimite morbidity. Twenty-two patients presented with limited stage disease (including two patients with centra1 nervous system metastasis as the only extra-thoracic site). There are 16 men, 6 women in this series. Their average age is 61. Tbeir average Karnofsky score is 75. The patients received Cyclophosphomide, CCNU, Methotrexate, Vincristine and split course irradiation of sites of bulk intrathoracic disease as we11 as the mediastinum and the cranial content to 3,000 rad in 30 fractions in 9 weeks. The complete remission rate in these patients is 72 percent. The median duration of complete remission is only 31 weeks; the maximum duration 46 weeks; the maximum survival 77 weeks; the one year survival 82 percent. The 50 percent survival is 56 weeks.

The first failure site after complete remission was pulmonary in 6 patients, hepatic in 1 and cutaneous in another. Intracranial relapse occurred in three patients but was not the first site of relapse in any of these patients.

Quality of survival is good. Toxicity of the combined modality regimen is acceptable. There are no treatment related deaths in this series.

(125) PRELIMINARY RESULTS OF COMBINED RADIATION AND CHEMOTHERAPY IN THE TREATMENT OF SMALL CELL CARCINOMA OF THE LUNG (A RANDOMIZED STUDY OF CANCER AND LEUKEMIA GROUP B)

Walter Eaton, M. D.l*, Herbert Maurer, F1. 0.1, Arvin Glicksman, M.D.2, Thomas Pajak, Ph.D.3, and Lawrence Reinstein, Ph.D.2

(1)Radiation Therapy, Dartmouth Medical School, Hanover, NH, 03755 (2)Radiation Therapy, Rhode Island Hospital, Providence, RI, 02902

(3)Cancer and Leukemia Group B, Scarsdale, NY, 10583

Despite a high remission rate due to combination radiotherapy and chemotherapy in smal1 cel1 carcinoma of the lung, improvement in long term survival in a signifi- cant proportion of responders has not been achieved. CALGB Protocol 7781 was

94 ARS 63rd Annual Meeting Radiation Oncology ??Biology 0 Physics

designed to investigate two drug regimens and local radiotherapy to the lesion in the chest in patients with limited disease. Al1 patients received prophylactic brain irradiation. Patients ‘were randomized to receive two courses of Nethotrexate, Adria- mycin, cyclophosphamide (Cytoxan) and lomustine (CCNU) or, CTX and CCNU alternating with Adriamycin and Vincristine. Radiotherapy to the primary tumor in the chest was given after six weeks of chemotherapy and consisted of 4500 rad to the primary lesion, mediastinum, and supraclavicular fossae using a split course technique.

NO significant differences in response rates have been observed between the two regimens, (complete response rates 51%) which is not substantially different from the previous CALGB three-drug regimen. Complications from the combination radiotherapy and chemotherapy have occurred such as esophagitis and symptomatic pneumonitis in less than 5% and are about equal with either chemotherapy schedule. Approximately 75% of the patients have relapsed in the chest. Of these, approximately 30% have been within the field of irradiation (Patients with CR-25%, patients with PR-33%.) This may be a dose-related failure.

Because of concern of the combined toxicity of radiotherapy and chemotherapy to the spinal cord, the protocol designated that the maximum dose to the spinal cord was to be 4200 rad. Various methods used to achieve this occasionally resulted in doses of 4200 rad or less to the mid-mediastinum and portions of the primary tumor. From data supplied by the Radiotherapy Quality Assurance Program of the CALGB, it was found that 75% of the cases in which a portion of the mediastinum received a dose less than 4000 rad have failed in-field, while less than 20% of the patients with appro- priate radiotherapy to the tumor (dose 4500 rad) had an in-field recurrence. These data and the implications of the observations have significante in determining the future role of radiotherapy in smal1 cel1 carcinoma of the lung.

(126)FAST FRACTIONATION - AN ALTERNATIVE TREATMENT FOR BRONCHOGENIC CARCINOMA

John Shaw, M.D., Jeffrey Shafer, M.D., Larry Jones, R.T.

Sacred Heart Genera1 Hospital, Eugene;Oregon

In a time when we are hearing tetms such as "tost effective," "tost containment," the radiation oncologist is faced almost daily with the diletmna of how to maximally treat bronchogenic carcinoma in the least amount of time, at the lowest tost. We have utilized the fast fractionation principle to achieve these goals with acceptable results. Twelve treatments of 400 rads Til were given over a total elapsed time of 32 days. The fields were loaded 2:1, anterior to posterior. Retrospectively, 64 patients were reviewed. Of these 20% were adenocarcinomas, 54% squamous cell, 26% large cel1 undifferentiated. 17% were Stage 11 while 43% were Stage 111 and 40% Stage IV. Considering al1 cel1 types and stages, 54% lived or are alive at 12 months, 29% at 18 months, 17% at 24 months and 9% at 36 months and greater. Conventional fractionation treatment is also given in our department to doses of 6000 rads plus. Costwise, the conventional fractionation treatment charges are 2 1/4 times greater and physics charges 3 times greater than the fast fractionation schedule. What is more important, the clinical results, side effects and survival of patients treated with the fast fractionation schedule were equivalent to or superior to those patients treated with conventional fractionation schedules.