Cytotoxic chemotherapy before and after radiotherapy compared with radiotherapy followed by chemotherapy in the treatment of small-cell carcinoma of the bronchus

Abstract

This report compares the results up to 36 months of two sequences of radiotherapy and chemotherapy for small-cell anaplastic carcinoma of the bronchus, of limited extent (defined below). A total of 91 patients were allocated at random to treatment with radiotherapy to the primary site followed by 10 pulses of chemotherapy using cyclophosphamide, methotrexate and CCNU (RC), and 95 to two pulses of the same chemotherapy, followed by radiotherapy, followed by 8 pulses of chemotherapy (CRC). The median survival times were 36 weeks for the RC series and 45 weeks for the CRC series but there was no statistically significant difference in survival (P = 0.9, log-rank test). At 12 months, 32 (35%) of the RC and 38 (40%) of the CRC patients were alive, at 24 months, 8 (9%) and 4 (4%), and at 36 months, 7 (8%) and 1 (1%) respectively. The patients' general condition, grade of activity and respiratory assessment correlated significantly with survival. Of 38 patients reported to be in "excellent" condition at the start of treatment, 6 (16%) were alive at 3 years. Although there was evidence that the onset of metastases was slightly delayed in the CRC series, this difference had disappeared by 12 months.