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Small cell carcinoma of the lung: results of combination chemotherapy and radiation therapy (COF vs. COFP randomized
Abstract:
Forty-three patients with small cell carcinoma were admitted to our hospital in 1977. These patients were treated with combined chemotherapy and radiotherapy, the latter being CO60 or 8 MEV Linac. The protocol for treatment is the following: 1) Chemotherapy, randomized into two groups COF (Cytoxan, Vincristin, and 5-fluorouracil) and COFP (Cytoxan, Vincristin, 5-Fu and Procabazine). 2) Radiotherapy with 2 split courses. In the rest period chemotherapy was given as randomized above for COF and COFP groups, but drugs given only once in this rest period, followed by the whole course of radiotherapy using same drugs as above, but only once a month for at least 2 years. The 1-year survival rates were 63.1% and 57.8% respectively, 2-year survival rates were 21% for both programs, and 3-year survival rates were 10.5% for both programs also. Therefore, we believe that procarbazine does not play a very important role in the program, and can be dispensed with. Compared with international reports, the efficacy of COF and COFP programs is as good as any other of the combined chemotherapy programs in the world. These programs may be of more benefit to the patients because of the very mild toxicity and very low cost. In this study the extent of the lesion was found to play important role in prognosis, in other words, the earlier the stage the better the results, just as for other solid tumors. Median survival time in Stage II groups is 20 months, the 1-year survival rate is 81.8% (8/11), 2-year survival rate is 45.4% (5/11), while in Stage III groups median survival time is 11.5 months, the 1-year survival rate is 57.1% (13/21), and 2-year survival rate is 14.2% (2/21). Because the survival time exceeded 18 months, there are 10 of 15 patients alive and without evidence of disease (66.6%), and 6 of 8 patients alive over 24 months without evidence of disease (75%). We offer a program that for maintenance combined chemotherapy periods should be prolonged to 2-3 or more years.