Studies of concomitant radiotherapy, chemotherapy, cancer-small cell lung shows promise

Treatment of limited stage lung cancer small cell (LSCL) with a combination of accelerated radiotherapy with high dose chemotherapy has shown encouraging results open the door to a large scale survey, according to new research from the 'University of Texas MD Anderson Cancer Center. The Phase II was today (November 3) in an oral presentation at the annual meeting of the American Society for Radiation Oncology (ASTRO), followed by Ritsuko Komaki, MD, Professor and Director of Research Cancer Lung and Thoracic Radiation Oncology, Department of Radiation Oncology at MD Anderson.

"While still early, these may the most important results of the study to a limited stage small cell lung cancer over the last ten years," said Komaki, lead author of the study. "This research is important because it is a high degree of disease control achieved while minimizing damage to the esophagus."

Treatment can be problematic

According to the American Cancer Society, lung cancer, the most common cause of cancer death among men and women in this country. Nearly 220,000 cases are diagnosed in 2009 and more than 159,000 people die of the disease.

Small cell lung cancer is an aggressive cancer that must be about 20 per cent of cases of lung cancer is about 20 percent of these cases are classified as LSCL such as cancer, as defined in one lung and the possible involvement of lymph nodes, but without metastases.

"In recent years we have made substantial progress made by the same chemotherapy and thoracic radiotherapy (irradiation of the breast), and prophylactic cranial radiotherapy (radiation) of the head to prevent cancer," said Komaki, which is also owned by Gloria Lupton Tennison Distinguished Chair for Research on lung cancer at MD Anderson. "It's survival to five years in certain limited circumstances stage lung cancer: small cell, only 26 per cent and the probability of recurrence and metastasis is still too high."

In an earlier Phase III trial at MD Anderson and other sites by the International North America, was fractionated radiotherapy (accelerated radiation increases over time) with simultaneous VP-16 (etoposide) and cisplatin (platinum-based drugs) improved survival rate at five years. But this treatment often causes other side effects.

"Severe inflammation of the lining of the esophagus, also known as acute inflammation of the esophagus is a significant risk with this type of treatment," Komaki said. "Therefore, despite its long-term survival advantages, this instrument is not widely used in community hospitals. "

"Supplements" increased radiation

Researchers at MD Anderson and their colleagues have developed this new study means to increase the amount of radiation during chemotherapy without having to find a simultaneous increase damage to normal tissue. To grant support from NCI, this clinical study was then proposed to the Radiation Therapy Oncology Group (RTOG).

Patients with chest LSCL were treated with radiotherapy, accelerates slowly for three weeks. The next step was to two weeks of high dose radiation twice a day for a total of five weeks. During radiotherapy, patients received four cycles of chemotherapy.

"We have the patient increases the radiation twice daily for the last two weeks of treatment, if the resistant cells to multiply often," Komaki says.

During the median follow up period of 19 months, 41 percent of patients with complete response and another 39 percent had a partial response. Despite the higher dose of radiation, the rate of severe acute inflammation of the esophagus significantly lower than the previous study, 18 per cent against 27 per cent.

However, 36.6 percent two years did not improve survival. In addition, while health checks on site was excellent, 80 percent of the majority of patients still in the development of distant metastases, Komaki said.

Further studies are planned

Komaki said further study is needed, possibly including a cycle of induction chemotherapy before concurrent processing. Improving systemic therapy and work-ups are also necessary, she said.

This study was supported by a new randomized Intergroup (CALGB / RTOG / ECOG / SWOG) which are adapted to register 700 patients in various locations across the country. This research will compare three doses and time of radiation treatment available.