Intensive combined-modality therapy in small cell lung cancer

Combination ifosfamide/carboplatin/etoposide (ICE) chemotherapy and ICE plus mid-cycle vincristine (VICE) are reviewed. Thoracic radiotherapy and prophylactic cranial irradiation given as single fractions in the majority of patients have been intercalated with VICE in the later studies. The patient populations have not been intensively staged with computed tomography, etc, but do have reasonable Karnofsky performance status ratings and biochemical screens. A policy of no dose reduction over six courses of VICE chemotherapy has been followed in three consecutive studies of 166 patients. The minimum length of follow-up is 26 months and the 2-year survival rate is > or = 30%. Hematopoietic growth factor support in an attempt to overcome the considerable myelosuppression with VICE therapy is currently being evaluated.