Unexpected toxicity of combined modality therapy for small cell carcinoma of the lung a southwest oncology group study

Robert B Livingston, Joaquin Mira, Charles Haas, Lance Heilbrun

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Combination chemotherapy with cyclophosphamide, vincristine, methotrexate and Adriamycin was delivered to 35 patients with small-cell carcinoma of the lung (28 with extenstive and 7 with limited disease), including elective administration of intrathecal methotrexate. Whole-brain irradiation (3000 rad in 10 fractions) was then administered, with concomitant systemic cyclophosphamide and methotrexate for patients with extensive disease. Those with limited disease received concomitant chest irradiation without chemotherapy. Maintenance therapy then involved cyclophosphamide 750 mg/m2 day 1, and methotrexate 30 mg/m2days 1 and 8, every 3 weeks. In only 2 patients reinduction was carried out at 24 weeks with the original chemotherapy. Myelosuppression was severe; there were at least 2 drug-related deaths from this cause in the induction period, and 15 febrile episodes with leukopenia. Stomatitis was more frequent and more severe in "maintenance" than in "induction" courses, especially the first maintenance course which was given with concomitant whole-brain irradiation. In addition, 13 episodes of unusual toxicity occurred in close temporal relation to systemic methotrexate administration, usually associated with stomatitis, in patients who were on maintenance therapy. These included 3 episodes of loss of consciousness, 4 of generalized erythroderma, 2 of "flu"-like syndrome, and I each of the following: fatal, bilateral interstitial pneumonia; reversible, eosinophilic pleural effusion; acute myocardial infarction; and renal compromise with hematuria. As a result of this unexpected and protean toxicity, the pilot study was discontinued. However, at this time seven patients (4 with extensive and 3 with limited disease) remain in complete remission.

Original languageEnglish (US)
Pages (from-to)1637-1641
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume5
Issue number9
DOIs
StatePublished - 1979
Externally publishedYes

Fingerprint

Combined Modality Therapy
Small Cell Lung Carcinoma
Methotrexate
toxicity
lungs
therapy
cancer
maintenance
chemotherapy
Cyclophosphamide
Stomatitis
irradiation
brain
induction
hematuria
leukopenia
Maintenance
myocardial infarction
pneumonia
consciousness

Keywords

  • Chemotherapy
  • Combined modality therapy
  • Irradiation
  • Small cell carcinoma of the lung
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Unexpected toxicity of combined modality therapy for small cell carcinoma of the lung a southwest oncology group study. / Livingston, Robert B; Mira, Joaquin; Haas, Charles; Heilbrun, Lance.

In: International Journal of Radiation Oncology Biology Physics, Vol. 5, No. 9, 1979, p. 1637-1641.

Research output: Contribution to journalArticle

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