Comparison of induction chemotherapy before radiotherapy with radiotherapy only in patients with locally advanced squamous cell carcinoma of the lung. The Swedish Lung Cancer Study Group.

The aim of this randomised trial was to investigate the effect of induction chemotherapy before radiotherapy on survival in 302 patients with non-resectable squamous cell carcinoma of the lung. Radiotherapy, 56 Gy to the chest, was given to 154 patients and combined treatment, with chemotherapy preceding the radiotherapy, to 148 patients. Chemotherapy consisted of three courses of cisplatin (120 mg/m2) and etoposide (100 mg/m2 i.v. for 3 days) administered every fourth week. Median survival was 10.5 months in the radiotherapy arm and 11 months in the combined treatment arm. The 2-year survival rate was 17% in the radiotherapy arm and 21% in the combined treatment arm. Addition of chemotherapy seemed to significantly improve survival, according to the Cox multivariate analysis (P = 0.04), but as only a trend according to life-table analysis (P = 0.11). Chemotherapy also accomplished a trend towards improved local control (P = 0.08) and towards decreased metastatic disease (P = 0.10). 2 patients in the combined treatment arm, but none in the radiotherapy arm, died from toxicity. The conclusion was that the value of the chemotherapy used in this study was very modest, but the results strongly support further research for more efficient drugs and combinations.

Carcinoma of the oesophagus, treated radiologically.

Radiotherapy according to a "small volume/large absorbed dose"-concept was given to 31 patients with carcinoma of the oesophagus. Tumour control in the treated volume was obtained in 52%, but only 13% of the patients survived for 6 years. Metastases outside the treated volume were seen in 65% of the patients. The palliative results may be judged as not optimal.

Vincristine, Adriamycin, cyclophosphamide, and etoposide (VP16-213) in small-cell anaplastic carcinoma of the lung.

Twelve patients with small-cell anaplastic carcinoma of the lung were treated with vincristine 1 mg/m2 i.v. day 1, adriamycin 50 mg/M2 i.v. day 1, cyclophosphamide 1,000 mg/m2 i.v. day 1, and etoposide 80 mg/m2 i.v. day 2, 4, 6 given on an outpatient basis and repeated at 3-week intervals. As consolidation therapy seven patients received two courses of BCNU median 29 mg/m2 (range 24-73 mg/m2) short term intraarterial infusion in the bronchial artery with 2 to 3-weeks intervals. One patient with limited disease had no evidence of disease for 13+ months and one patient complete remission for 3+ months. Four of ten patients with extensive disease had complete remission for median 5 months (range 2+ to 5+ months) and four patients had partial remission for median 5 months (range 4 to 5+ months). Despite side effects the chemotherapy was well tolerated by the patients. The results correspond to those obtained with other effective regimens in small-cell anaplastic carcinoma of the lung.

Combination chemotherapy in advanced postmenopausal mammary carcinoma. A comparison between VAC and VACM therapy.

A randomized trial comparing Vincristine, Adriamycin, Cyclophosphamide (VAC) with or without Methotrexate with citrovorum factor rescue (VACM) was performed in 64 patients with metastatic postmenopausal mammary carcinoma. Previous treatment of metastases, dominant site of metastases and performance condition were similar in the patients. No significant difference was found in the response rates (complete remission + partial remission; VAC 21/31, VACM 25/33), in the duration of the remissions or in the survivals. The duration of remission in CR was significantly longer than in PR. No serious side effects were observed. The VAC regimen is preferable, particularly with respect to the costs and the simple procedure of administration.

Postoperative radiation therapy in mammary carcinoma stage II. Target volume, organs at risk, absorbed dose, time-dose schedule, and dose to organs at risk in a prospective investigation.

A standardized programme for postoperative radiation therapy of carcinoma of the breast stage II is reported. The target volume and the organs at risk are defined, and the target absorbed dose and fractionation are specified. The irradiation techniques is briefly described.

Phase II study of combined vincristine, adriamycin, cyclophosphamide, and methotrexate with citrovorum factor factor rescue in metastatic breast cancer.

Fifty patients with metastatic breast cancer were treated with 8-day courses of vincristine (1 mg iv, Day 1), adriamycin (50 mg/m2 iv, Day 1), cyclophosphamide (100 mg/m2 orally, Days 1-8), methotrexate (200 mg iv by 3-hour infusion, Day 8), and citrovorum factor rescue (15 mg in 12, 18, and 24 hours after methotrexate, Day 8) at 3-4-week intervals. Forty-two patients had previously received treatment with hormones and 17 patients had received chemotherapy. Fifteen patients achieved a complete remission (CR) and 24 patients a partial remission (PR). There was a significant correlation between the response and the number of metastatic organs (0.01 less than P less than 0.02). The response rate was roughly uniform irrespective of the organ predominantly involved (0.2 less than P less than 0.3). The remission duration was significantly longer for the patients with CR compared with that for the patients with PR (0.001 less than P less than 0.01). The patients who achieved CRs and PRs survived significantly longer than the patients with no change and progressive disease (P less than 0.001). The toxic effects of the treatment were acceptable and no drug-related deaths occurred.