title: Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: A randomized study.
abstract: OBJECTIVE
  To investigate the efficacy and toxicity of cisplatin/etoposide (PE) chemotherapy (CHT) with or without accelerated hyperfractionated radiation therapy (ACC HFX RT) and concurrent daily carboplatin/etoposide (CE) in patients with extensive-disease small-cell lung cancer.
  
  
  METHODS
  A total of 210 patients were treated with three cycles of standard PE. Patients with a complete response (CR) at both the local and distant levels (CR/CR) or a partial response (PR) at the local level and CR at the distant level (PR/CR) received either thoracic ACC HFX RT with 54 Gy in 36 fractions over 18 treatment days in combination with CE followed by two cycles of PE (group 1, n = 55) or an additional four cycles of PE (group 2, n = 54). Patients who experienced less response were treated nonrandomly (groups 3, 4, and 5). All patients with a CR at the distant level received prophylactic cranial irradiation.
  
  
  RESULTS
  For 206 assessable patients, the median survival time (MST) was 9 months and the 5-year survival rate was 3.4%. Patients in group 1 had significantly better survival rates than those in group 2 (MST, 17 v 11 months; 5-year survival rate, 9.1% v 3.7%, respectively; P =.041). Local control was also better in group 1, but the difference was only marginally not significant (P =.062). There was no difference in distant metastasis-free survival between groups 1 and 2. Acute high-grade toxicity was higher in group 2 than in group 1.
  
  
  CONCLUSIONS
  The addition of ACC HFX RT to the treatment of the most favorable subset of patients led to improved survival over that obtained with CHT alone.
authors.affiliation: Departments of Oncology and Surgery, University Hospital, Kragujevac, Yugoslavia.
authors.forename: B
authors.initials: B
authors.lastname: Jeremic
authors.forename: Y
authors.initials: Y
authors.lastname: Shibamoto
authors.forename: N
authors.initials: N
authors.lastname: Nikolic
authors.forename: B
authors.initials: B
authors.lastname: Milicic
authors.forename: S
authors.initials: S
authors.lastname: Milisavljevic
authors.forename: A
authors.initials: A
authors.lastname: Dagovic
authors.forename: J
authors.initials: J
authors.lastname: Aleksandrovic
authors.forename: G
authors.initials: G
authors.lastname: Radosavljevic-Asic
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011446:Prospective Studies; D011878:Radiotherapy / Q000379:methods; D015996:Survival Rate; D015022:Yugoslavia / Q000453:epidemiology
chemical_list: D005047:Etoposide; D002945:Cisplatin