[Time factor in radiotherapy and chemotherapy for small cell lung cancer]

Selection of treatment schedule in patients with small cell lung cancer (SCLC) appears to be a subject of controversies. One of the most controversial issue is influence of planned and unplanned gaps in radiotherapy and chemotherapy on efficacy of radical treatment of patients with limited disease. These controversies created the basis for current research.

245 patients with LD-SCLC treated in Cancer Center in Gliwice between 1989 and 2001 were included in the present analysis. There were 60 women and 185 men, median age 58 years; All these patients were in good general condition. Cisplatine based chemotherapy and total radiation dose higher than 30Gy were used in all of them.

Overall survival was analyzed using Kaplan-Meier analysis. The variables potentially influencing overall survival including dose-intensity of chemotherapy and radiotherapy were analyzed using multivariate Cox regression model.

3-year actuarial overall survival in a whole group of patients was 10 percent. The following variables had negative influence on overall survival in multivariate Cox model: performance status ZUBROD higher than 0 (p<0.0001), metastases to supraclavicular nodes (p=0.001), dyspnoea according to Borg scale higher than 2 (p=0.004) and radiation dose intensity less than 80% (p=0.02). Gaps in chemotherapy did not appear significant.

Radiation treatment gaps had significant negative influence on survival of the patients with LD-SCLC, while interruptions of chemotherapy did not. This may suggest that within the range of doses and dose-intensities used in this group, interruptions of chemotherapy due to treatment toxicity are justified, while interruptions of radiotherapy should be promptly avoided.