ORE PERSONS IN THE United States die from non-small cell lung cancer (NSCLC) than from breast, colorectal, and prostate cancer combined. 1 Each year, more than 60000 persons develop stages IIIB and IV NSCLC; nearly all go on to die from metastatic spread. In addition, most individuals experience symptoms caused directly by lung cancer. These symptoms are often the first manifestations of the illness and increase in frequency and severity as the disease progresses. Cough, shortness of breath, weight loss, loss of appetite, and chest tightness impair the quality of lives already cut short by NSCLC. For patients with advanced lung cancer, physical well-being and changes in quality of life correlate with survival. 2 Espe-Author Affiliations and Financial Disclosures are listed at the end of this article.

For children with acute lymphoblastic leukemia in a second remission, bone marrow transplants from HLA-identical siblings result in fewer relapses and longer leukemia-free survival than does chemotherapy.

To address the problem of historically poor results in the treatment of children with advanced-stage Burkitt's lymphoma and B cell (SIg+) acute lymphoblastic leukemia (ALL), an intensive chemotherapy regimen was devised using the most effective single agents in high-dose short courses. Treatment commenced with a fractionated schedule of intravenous (IV) cyclophosphamide (300 mg/m2 every 12 hours for six doses) followed immediately by Adriamycin (50 mg/m2) and vincristine (1.5 mg/m2) with combined intrathecal (IT) methotrexate and cytarabine. Predictably, this treatment produced virtually complete disappearance of all tumor and profound myelosuppression. Immediately on hematologic recovery, IV high-dose methotrexate (1,000 mg/m2 over 24 hours) followed by IV cytarabine (400 mg/m2 over the next 48 hours) was administered with leucovorin rescue and repeated IT treatments. The treatment sequence described above is repeated four times, with the dose of cytarabine doubled in succeeding courses, up to 3,200 mg/m2. The entire planned therapy required approximately 24 weeks. Since 1981, we treated a total of 29 children with this approach, 19 of whom had massive unresectable intraabdominal tumor. According to initial extent of disease, 17 were classified as stage III, four as stage IV non-Hodgkin's lymphoma (NHL), and eight as B cell ALL. Eight of the 12 patients with stage IV NHL or B cell ALL had initial involvement of the CNS. Twenty-seven of 29 patients (93%) attained a complete remission. Fourteen of 17 stage III NHL patients remain disease free, for periods ranging from 3+ months to 4 1/2+ years. The actuarial estimate of the proportion of stage III patients remaining disease free at 2 years is 81%. Results in patients with initial involvement of the CNS and/or marrow are much less favorable, with only two of ten patients who attained remission apparently being cured. In addition to stage, the initial serum lactic dehydrogenase (LDH) level emerged as a prognostic indicator, higher levels (over 1,000 IU/L) being associated with the worst prognosis (P less than .05). Major toxicity consisted of severe hematopoietic suppression and febrile episodes associated with neutropenia. We conclude that this treatment is highly effective for advanced-stage Burkitt's tumors in children free of initial CNS involvement.

Table 1 of the report "A Prospective Comparison of Neuropsychologic Performance of Children Surviving Leukemia Who Received 18-Gy, 24-Gy, or No Cranial Irradiation" (J Clin Oncol 9:1348–1356, 1991) contained an error. lt is reprinted here correctly in its entirety: Please see the PDF for Table.