Prophylactic cranial irradiation in complete responders with small-cell lung cancer: analysis of the Mayo Clinic and North Central Cancer Treatment Group data bases.

Shaw, Edward G.; Su, John Q.; Eagan, Robert T.; Jett, James R.; Maksymiuk, Andrew W.; Deigert, Fred

doi:10.1200/jco.1994.12.11.2327

Cited by 54 publications

(22 citation statements)

References 8 publications

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“…For Ͼ 800 patients with extensivestage SCLC who were treated on protocols during that period, the median survival was 9.3 months, and the 2-year survival rate was 2%. 2 Our previous results, as well as results from other cooperative groups, are very similar to the current trial and do not suggest any advantage of the alternating chemotherapy schedule reported here over standard therapy with etoposide and cisplatin. 1,11,12 Recently, the ECOG performed a Phase III trial in patients with extensive-stage SCLC in which all patients received four cycles of etoposide plus cisplatin.…”

Section: Discussionsupporting

confidence: 77%

“…7 Although the results of this trial were good, with a response rate of 77% and a median survival of 10.5 months, they were similar to the results reported in prior NCCTG trials and in other cooperative group trials. 1,2,18,19 In 1994, the NCCTG reported on the treatment of Ͼ 200 patients with extensive-stage SCLC using four different schedules and sequences of etoposide and cisplatin, resulting in a median survival of 9.5-11.1 months and a 2-year survival rate of 4 -12%. 1 Shaw et al reviewed the NCCTG and Mayo Clinic data base of patients enrolled in Phase II-III trials from 1975 to 1990.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the median survival is only 8 -9 months, and the 2-year survival rate is Յ 10% in most reports. 1,2 The major problem is that SCLC develops rapid resistance to therapy, and response to second-line therapy is limited.…”

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confidence: 99%

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Alternating chemotherapy with etoposide plus cisplatin and topotecan plus paclitaxel in patients with untreated, extensive‐stage small cell lung carcinoma

Jett

Hatfield

Hillman

et al. 2003

Cancer

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BACKGROUNDThe objective of this study was to test the response rate and toxicity of alternating chemotherapy in previously untreated patients with extensive‐stage small cell lung carcinoma (SCLC).METHODSPatients with histologically proven, extensive‐stage SCLC, with a performance status of 0–2, and who had received no prior chemotherapy were eligible. The design was a two‐stage, Phase II, multicenter trial. Treatment consisted of alternating chemotherapy every 3 weeks with etoposide (100 mg/m2 on Days 1–3) and cisplatin (30 mg/m2 on Days 1–3) on Cycles 1, 3, 5 and with topotecan (1 mg/m2 on Days 1–5) and paclitaxel (200 mg/m2 on Day 5) on Cycles 2, 4, and 6. Filgrastim support was given with Cycles 2, 4, 6.RESULTSForty‐four patients were eligible and evaluable. The primary toxicity was myelosuppression. The median absolute neutrophil count was 300/μL with 70% Grade 4 neutropenia. The median platelet count was 58,000/μL with 23% Grade 4 thrombocytopenia. Grade 4 nonhematologic toxicities occurred in 16% of patients. Overall toxicities were not different between the two regimens. There were no treatment‐related deaths. Complete or partial responses occurred in 34 patients (77%). The median time to progression was 6.9 months, with a median survival of 10.5 months and with 1‐year and 2‐year survival rates of 37% and 12%, respectively.CONCLUSIONSThe regimen of alternating chemotherapy was associated with substantial myelosuppression and resulted in a high response rate and good overall survival. The results were similar to those reported in prior trials and did not suggest any improvement in therapy for patients with SCLC. Cancer 2003;10:2498–503. © 2003 American Cancer Society.DOI 10.1002/cncr.11377

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Alternating chemotherapy with etoposide plus cisplatin and topotecan plus paclitaxel in patients with untreated, extensive‐stage small cell lung carcinoma

Jett

Hatfield

Hillman

et al. 2003

Cancer

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“…It was clear that the risks and benefits of PCI needed to be formally assessed in a prospective randomized trial. This view was echoed in the retrospective reviews that continued to appear from around the world in the early 1990s [10][11][12], which uniformly demonstrated decreased overt brain metastases, but only sometimes suggested improved survival. The methodological shortcomings of the early investigations and growing concern about cost and hazard versus benefits of PCI led to the design and launch of a new wave of randomized trials in the late 1980s and early 1990s.…”

Section: Impact Of Pci On Survival In Sclcmentioning

confidence: 89%

Prophylactic Cranial Irradiation in Small-Cell Lung Cancer

Yang

Matthews

2000

The Oncologist

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Prophylactic cranial irradiation is now known to improve survival to a significant degree in small-cell lung cancer (SCLC) patients; this is in addition to its established role in preventing the disabling symptoms of brain metastases. New information indicates that it confers a survival benefit for limited or extensive stage SCLC patients gaining a complete response in the chest. A review of causes of cerebral dysfunction as a complication indicates that such problems can be due to suboptimal radiation fractionation, chemotherapy, or an inappropriate combination of prophylactic brain irradiation with chemotherapy. Optimum treatment with prophylactic brain irradiation has been shown not to cause adverse effects with detailed psychometric testing. Several additional sources of information can be drawn together to suggest a dose-response pattern for prophylactic brain irradiation, leading to the recommendation that a dose of 25-36 Gy is optimal, delivered in 2-3 Gy daily fractions after the completion of chest irradiation and chemotherapy. This will be better defined in future clinical trials.

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“…A reason may be the unclear benefit concerning overall survival. Some studies [6,7] found that PCI was not associated with a …”

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confidence: 99%

Prophylactic Cranial Irradiation in Limited-Disease Small-Cell Lung Cancer – Why, When, How Much?

Bohrer

Wenz²

2002

Oncol Res Treat

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Prophylactic cranial irradiation in complete responders with small-cell lung cancer: analysis of the Mayo Clinic and North Central Cancer Treatment Group data bases.

Abstract: The use of PCI remains controversial outside the setting of a clinical trial.

Cited by 54 publications

References 8 publications

Alternating chemotherapy with etoposide plus cisplatin and topotecan plus paclitaxel in patients with untreated, extensive‐stage small cell lung carcinoma

Alternating chemotherapy with etoposide plus cisplatin and topotecan plus paclitaxel in patients with untreated, extensive‐stage small cell lung carcinoma

Prophylactic Cranial Irradiation in Small-Cell Lung Cancer

Prophylactic Cranial Irradiation in Limited-Disease Small-Cell Lung Cancer – Why, When, How Much?

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