Concurrent approaches to combined chemotherapy and chest radiotherapy for the treatment of patients with limited stage small cell lung cancer.

The addition of chest radiotherapy to combination chemotherapy has been shown to prolong survival of patients with limited stage small cell lung cancer. Treatment of these patients with concurrent etoposide cisplatin and chest radiotherapy has resulted in a median survival of 18-27 months with a 2-year projected actuarial survival of 36-65%. The alternation of etoposide cisplatin (EP) with vincristine, doxorubicin, and cyclophosphamide (VAC) has been associated with prolonged survival in a single trial of patients with limited stage small cell lung cancer treated with combined modality therapy. Timing of the alternation of the two regimens (EP and VAC) in the first, second, or fourth cycle has not been shown to be an important determinant of survival for patients in single arm studies. Three studies evaluating early (within 1 month of starting chemotherapy) versus late (3-4 months after starting chemotherapy) chest radiotherapy in concurrent regimens, have shown early chest radiotherapy is associated with longer survival in one study while the other two show no difference in survival. Further clinical research will continue to define the appropriate ways to combine chemotherapeutic agents and chest radiotherapy to maximize the survival of patients with small cell lung cancer.