Treatment Toxicities in Long-Term Survivors of Limited Small Cell Lung Cancer

Abstract

A total of 211 patients with limited small cell lung cancer were assessed retrospectively for long-term toxicities, treatment-related deaths, and second primaries. All had received treatment with various combinations of doxorubicin, vincristine, cisplatin, lomustine, cyclophosphamide, and etoposide with or without split-course thoracic radiotherapy (4,000 cGy/10 fractions) and/or split-course prophylactic cranial irradiation (3,600 cGy/10 fractions). Sixty-eight (32%) of the patients survived longer than 1.5 years and formed the basis of this study. Debilitating pulmonary, cardiac, and neurologic toxicity was noted in 12%, 14%, and 15%, respectively, of long-term survivors. These complications were the result of aggressive combined modality therapy. Certain drugs appeared to cause additive toxicity when combined with radiation. Three patients developed new primary tumors of squamous cell origin. Attention must be directed to defining the safest way to employ aggressive combined modality treatment for these patients.

Long-Term Results of Combination Chemotherapy with or without Irradiation in Small Cell Lung Cancer: A 5- to 11-Year Follow-Up.

“…This maycertainly be related to the modeof treatment; the total dose of ADM and the sequence of chemotherapy and TRT. The cumulative ADMdose in our series was less than 360mg/m2in patients receiving either COMP-VAN or CAV-EP,which was much less than in Frytak's series of patients (22). Regarding TRT, patients in the former trial received TRTbetween cycle 1 and 2 to avoid concurrence with chemotherapy, and patients in the latter trial received it sequentially after they achieved a maximal response to chemotherapy.…”

Primary Analysis of a Phase II Randomized Trial Radiation Therapy Oncology Group (RTOG) 0212: Impact of Different Total Doses and Schedules of Prophylactic Cranial Irradiation on Chronic Neurotoxicity and Quality of Life for Patients With Limited-Disease Small-Cell Lung Cancer

“…Several factors in the literature have been reported as being associated with the risk of long-term neurotoxicity, including age greater than 60 years [25], a daily fraction size of greater than 3 Gy [25, 26, 27, 28, 29], and concurrent use of chemotherapy during PCI [25, 26, 28, 30, 31, 32, 33]. In RTOG 0212, age as a continuous variable was the most significant predictor of CNt (p = 0.005).…”

Feasibility of reducing the irradiation dose in regions of active neurogenesis for prophylactic cranial irradiation in patients with small-cell lung cancer

“…Observations suggesting that chemotherapy has harmful effects are supported by research on neurocognitive abilities in patients after chemotherapy for SCLC showing reduced baseline (as- sessed prior to radiotherapy) scores in neurocognitive tests in a significant number of examined patients. In most published studies, the numbers range between 15% and 70%, but some authors claim that baseline memory and cognitive abilities are significantly impaired in virtually all chemotherapy-exposed patients [4,5,26]. On the other hand, there is increasing evidence of the detrimental effects of WBRT.…”