Cyclic alternating polychemotherapy with or without upper and lower half-body irradiation in small cell anaplastic...

Ninety-six patients with small cell anaplastic lung carcinoma were given monthly chemotherapy with vincristine-doxorubicin-cyclophosphamide alternating with CCNU-methotrexate-etoposide for 18 months or until evidence of progressive disease. Forty-four patients were randomized to chemotherapy alone and 52 patients to chemotherapy plus 600 cGy of both upper and lower half-body irradiation given day 60 and 100, respectively. In 78 evaluable patients surviving more than 100 days the overall response rate was identical in the two arms of the study, 68% vs. 66%. However, time to progression was significantly shorter in the irradiated patients (P = 0.05). Only 25% of the irradiated patients tolerated greater than or equal to 75% of the scheduled dose of chemotherapy, against 91% of the non-irradiated patients (P = 0.0001). Thus, half-body irradiation was associated with a shorter time to progression and a decreased ability to give maintenance chemotherapy at proposed doses.