Combined platinum etoposide with radiation therapy in limited stage small cell lung cancer: an effective treatment strategy

Phase II study of concomitant chemoradiotherapy in bulky refractory or chemoresistant relapsed lymphomas

PURPOSE

To evaluate the local efficacy of concomitant chemoradiotherapy in patients with mostly refractory lymphoma.

METHODS AND MATERIALS

Patients with refractory or chemoresistant-relapsed lymphoma and bulky life-threatening masses were included in this study. A split course of concomitant radiotherapy and chemotherapy (mostly cisplatin and etoposide) was delivered during a 6-week period. Weekly blood tests and a clinical examination using the Radiation Therapy Oncology Group guidelines were performed to assess acute toxicity. The tumor response was evaluated 1-3 months after treatment and at regular follow-up visits.

RESULTS

We enrolled 21 patients in the study between January 1998 and April 2003. Of the 21 patients, 60% had disseminated disease with bulky tumor masses and 85% had refractory lymphoma, of which most had been treated with at least two different chemotherapy regimens before concomitant chemoradiotherapy. Seventy-five percent received regimens containing cisplatinum and etoposide. The median radiation dose was 40 Gy (range, 12-62.5 Gy). Grade 3-4 hematologic toxicity and mucositis was observed in 70% and 30% of cases respectively, without any deaths. The overall response and complete remission rate was 70% and 20%, respectively. The 1-year overall survival and local progression-free survival rate was 20.4% and 54%, respectively. Three patients with localized disease were still alive 16, 33, and 48 months after treatment.

CONCLUSION

Concomitant chemoradiotherapy for refractory or chemoresistant-relapsed lymphoma induced high hematologic toxicity, but seemed adequate for controlling local bulky tumor masses. No toxicity-related death was observed.

Small cell carcinoma of the lung: an "updated" overview

OBJECTIVES

To review the current status and recent advances, and ongoing research efforts related to the diagnosis, staging, and treatment of small cell lung cancer (SCLC).

DATA SOURCES

Review articles, book chapters, research studies, and abstracts relating to SCLC.

CONCLUSIONS

SCLC is the most aggressive type of lung cancer with many patients having widespread disease at the time of diagnosis. It is the most treatment responsive lung cancer to both chemotherapy and radiotherapy, with aggressive chemotherapy the cornerstone of treatment. Yet, the survival rate is limited. Several new drugs have been found to be active and it is hoped that they will lead to improved results.

IMPLICATIONS FOR NURSING PRACTICE

An understanding of the prognostic factors, staging, treatment modalities, and new therapies for SCLC will help nurses assist patients to make educated decisions about the potential risks and benefits of their therapeutic options.