Small cell cancer of the lung : an initial evaluation of the Yale treatment protocol

SMALL CELL CANCER OF THE LUNG: AN INITIAL EVALUATION OF THE YALE TREATMENT PROTOCOL David Jonathan Birnkrant 1985 A review of small cell cancer of the lung (SCCL) is presented, followed by initial results from the Yale University treatment protocol for SCCL. The review includes selected topics on the epidemiology, etiology, cytogenetics, cytomorphology, cells of origin, cell products, clinical diagnosis, staging, prognosis, and treatment of SCCL. The tumor emerges as one of diverse clinical behavior and cellular character; it remains poorly understood. Despite intermediate or slow doubling time, dissemination of the tumor—microscopic or gross—is the rule at diagnosis. Modest success has been achieved in treatment, allowing a small group of patients to go on to long-term survival (4 or 5 years), but most patients relapse after initial response to therapy and second-line therapy is rarely effective. Special attention is paid to treatment design, including the role of prophylactic cranial irradiation (PCI), adjuvant radiation therapy, and the concept of local tumor control. Results from the Yale University treatment protocol are presented. Thirty-nine evaluable patients were prospectively randomized to therapy with cyclophosphamide, Adriamycin, and vincristine (CAV) every 21 days or CAV alternating with Etoposide (VP-16-213). All limited disease (LD) patients underwent thoracic irradiation; complete responders received PCI. Eighty percent of LD patients achieved complete response as did 12% of extensive disease (ED) patients. Projected median survival ranged from 198 days for ED non-responders to 560 days for LD complete responders. It is too early to report on long-term survival. Addition of Etoposide (E) afforded no significant survival advantage over the CAV regimen. Etoposide added no significant additional toxicity; in fact, the percentage of patients experiencing infections requiring hospitalization was lower in the CAV/E group (6% vs. 33%). This may be the result of a smaller proportion of patients on CAV/E experiencing leukopenia (44% vs. 76%).