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SHALL CELL LUNG CANCER (SCLC) NEGATIVE RESULTS OF A RANDONIZED CLINICAL TRIAL ON DELAYED

THORACIC RADIOTHERAPY ADMINISTERED TO COMPLETE RESPONDERS (CR) PATIENTS. B. LEBEAU , C 1. CHASTANG. J.H. BRECHOT for the “Petites Cellules” Group (02 PC 85 proto;;:). Π; de Pneumologie, HBpital St Antoine, Faubours St-Antoine, 75571 Paris CBdex 12. Fkance. From October 1. 1985 to April 30, 1988. h34 pts with SCLC entered a multicenter (27 centers) randomized clinical trial. After a double initial randomization,

1 atients received or not five weeks of subcutaneous eparin and received either every four weeks

sequential (CCNU, Cytoxan, Adriamycin, VP16) or a: alternating chemotheraov (CCNU. Cvtoxan. Adriamvcin alterned cith CDDP, v’ihdesine, Vp16). tomplete -and oartial resoonders (CR+PR) received 8 courses of the latter regimens. 54 pts in CR at this time agreetnf;;

randomization between ~ela”peswe (26 pts

no treatment 18 limited and 8 disseminated) and

60 Gy equivaleit thoracic radiotherap limited and 10 disseminated). Indee lI

(28 pts. 18 nine centers

did not randomize patients as they used or never used thoracic irradiation. At the reference date of January 1. 1991 no Results are summarize c!

atient was lost to follow-up. in this table :

OPTIMIZING THE ROLE OF RADIOTHERAPY IN THE TREATMENT OF UMITED STAGE SMALL CELL LUNG CANCER (LSCLC)

P. Coy, N. Murray, J. Pater, I. Hodson, A. Arndd, E. Kostashuk, P. Dlxon, B. Zee, A. Sadura, J. Ayoub, M. Levitt, R. Wietzbickl, W. K. Evans, R. Feld, D. Payne, J. Maroun & K. Wilson, National Cancer Institute of Canada Clinical Trials Group

The importance of the timing of Thoracic Irradiation (Tl) was assessed in a multi-institution randomized study. 308 patients with LSCLC were eligible for analysis and were to recehre three cycles of Cycle+ phosphamide, Doxorubicin and Vincristine alternating with three cycles of Etoposide and Clspiatin (EP). Patients were randomized to receive TI (40 GY in 15 fractions in 3 weeks with treatment planning techniques to limit the spinal cord dose to be equal fo or less than 35 GY) either with the first cycle of EP (early) or with the sixth cycle of chemotherapy (late). Responding patients received prophylactic brain irradiation (25 GY in 10 fractions in 2 weeks). Ninety-&x per cent of the patients in the early arm and 87% of those in the late arm had received TI; 26 patients did not receive TI. All patients have been followed for at least 2 years and the median follow up is 4 years. 64% had CR in the early arm compared with 56% in the late arm (P = 0.137). There was a significant improvement in survival in the early arm-- median survival was 20 months compared with 15 months (P = .016 log rank test), survival at 2, 3 and 4 years was 40%, 31% and 24% respectively for the early arm and 34%, 22% and 15% for the late arm. 30% of patients In the early arm had recurrence In the chest as the first site of recurrence compared with 29% in the late arm. Brain metastases developed in 28% of patients in the late arm compared wlth 18% in the early arm (P = 0.04). We conclude that early administration of TI in a combined modality treatment is superior to late consolidative TI in limited small cell lung cancer. Local regional recurrence in the chest is a major problem to be solved.

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Radiotherapy Planning of Lung Cancer using CT Simulation System

Takeyuki Kusima,M.D., Kazufumi Imanaka,M.D., Michio Kono,M.D., Department of Radiology; Kobc University.

[Purpose] To put more accurate radiotherapy into practice, we have been developing the radiotherapy planning system using m, which is named CT Simulation System(CTSS) and applied to lung cancer. We introduce the ontline of this system and asses the clinical usefulness of CI’SS in therapy planning of lung cancer. [Method and Material] This system consists of CT Scanner (GE 9800 High-Light

Quick).Image processing work station ( RT/Marker YMS) and Linear accelcrator(ML UIMDX). In this system, it is possible to grasp the tumor extent three dimensionally by reconstructing CT axial images. We can define the tumor extent more accurately, so more accurate treatment planning and moTe appropriate choice of radiation method is feasible. [Results and Discussion] mS enables to reduce the irradiated volume because an

appropriate radiotheray can bc planned, which contriutcs the alleviation of side effert of radiotherapy. CISS brings wider indication of radiotherapy and benefits

in cases with were prcvioushy thought to bc difficult to perform radiothrapy.

Survival Me$ian 1 TZar 2 yE$rs 3 y$trs

R al th 333 d 86 % 36 % 25 % I&~rasc?~on 503 d 100 96 46 % 31% 5

: * 2nd randomization ??* 1st randomiza.tion ;E after .8 chemotherapy courses with obtentlon of

extension remained a maJor ( ~0.0004).

pro nostlc factor

1 In conclusion this late. t 9, racic radio-

t erapy seems to worsen the rank test

a ointed

prognosis (but the log; out no dl ference for survival

p=O.56) an that is in contrast with its efficiency when used earlier.

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