title: Limited-stage small-cell lung cancer treated  with early chemo-radiotherapy: the impact  of effective chemotherapy.
abstract: OBJECTIVE
  Small cell lung cancer is characterized by an aggressive clinical course and a high sensitivity to both chemotherapy and radiotherapy. We present the Florence University experience in concurrent early radio-chemotherapy in patients affected by limited-stage small cell lung cancer, with particular emphasis on treatment safety, disease outcome and prognostic factors.
  
  
  METHODS
  Fifty-seven patients were treated between June 2000 and February 2005. All patients underwent platinum-based chemotherapy, administered intravenously following two different regimens, for at least three cycles. Eighteen patients (31.6%) received epirubicin and ifosfamide in 3-week cycles alternating with etoposide and cisplatin, administered on day 1 to 3; 39 patients (68.4%) received etoposide and cisplatin. A total of 6 cycles were planned. Radiotherapy was administered concurrently to the first cycle of etoposide and cisplatin.
  
  
  RESULTS
  Clinical stage (P = 0.036) and number of chemotherapy courses (P = 0.009) emerged as the only significant death predictors at univariate analysis. Number of chemotherapy courses persisted as a significant death predictor also at multivariate regression analysis, with a reduced death risk for 5-6 chemotherapy cycles in comparison to 3-4 cycles (hazard ratio, 0.44). At a mean follow up of 38.5 months (standard deviation, 3.24 years; range, 6-164 months), considering the best overall tumor response achieved at any time during the whole treatment period, we obtained 32 complete responses (56.1%), 23 partial responses (40.3%) and 2 stable diseases.
  
  
  CONCLUSIONS
  Our analysis showed that concurrent early radio-chemotherapy in limited-stage small cell lung cancer treatment represents a safe and effective approach in patients. We confirmed the relevant impact on overall survival of effective chemotherapy delivery.
authors.affiliation: Department of Radiation-Oncology, University of Florence, Florence, Italy. v.scotti@dfc.unifi.it
authors.forename: Vieri
authors.initials: V
authors.lastname: Scotti
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.forename: Andrea
authors.initials: A
authors.lastname: Rampini
authors.forename: Carla
authors.initials: C
authors.lastname: De Luca Cardillo
authors.forename: Paolo
authors.initials: P
authors.lastname: Bastiani
authors.forename: Monica
authors.initials: M
authors.lastname: Mangoni
authors.forename: Benedetta
authors.initials: B
authors.lastname: Agresti
authors.forename: Carmine
authors.initials: C
authors.lastname: Santomaggio
authors.forename: Vanessa
authors.initials: V
authors.lastname: Di Cataldo
authors.forename: Ciro
authors.initials: C
authors.lastname: Franzese
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Biti
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D015251:Epirubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide