According to a recent article published in the Journal of Clinical Oncology, radiation and chemotherapy administered at the same time (concurrently) during treatment improves responses compared to sequential administration of the same treatment in limited-stage small cell lung cancer.

Small cell lung cancers account for 20-25% of all lung cancers and are primarily diagnosed in smokers or former smokers. SCLC differs from other types of lung cancer in that it tends to spread very quickly throughout the body via the blood and lymphatic system. Limited SCLC refers to cancer that is present in only one location in the chest. The most common form of treatment for patients with limited SCLC is combination chemotherapy plus radiation to the chest and sometimes, preventive radiation to the head. Researchers have been evaluating different treatment schedules with radiation and chemotherapy in order to determine the most effective delivery sequence.

Recently, researchers from Japan conducted a clinical trial to compare different treatment schedules in patients with limited SCLC. This trial involved 228 patients who were divided into two groups: one group received radiation beginning on the second day of the initial course of chemotherapy (concurrent) or radiation after the fourth cycle of chemotherapy (sequential). Chemotherapy consisted of Platinol® (cisplatin) and etoposide (VePesid®). A complete disappearance of cancer was achieved in 40% of patients treated with concurrent therapy, compared to 27% of patients treated with sequential therapy. Two years following therapy, 51% of patients treated with concurrent therapy were alive, compared to only 35% of patients treated with sequential therapy. Five years following therapy, 24% of patients treated with concurrent therapy were alive, compared to only 19% of patients treated with sequential therapy. Low blood cell levels and inflammation of the esophagus were more severe in patients treated with concurrent therapy.

These researchers concluded that concurrent administration of radiation and chemotherapy appears to improve survival compared to sequential administration in treatment of limited SCLC. Patients with limited SCLC may wish to speak with their physician regarding the risks and benefits of concurrent administration of chemotherapy and radiation or the participation in a clinical trial evaluating other novel therapies. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

Reference: Takada M, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stages small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104.

Journal of Clinical Oncology. 2002;20:3054-3060.

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