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Chapter 085. Neoplasms of the Lung (Part 17)

Chemotherapy The chemotherapy combination most widely used for SCLC is etoposide plus cisplatin or carboplatin, given every 3 weeks on an outpatient basis for four to six cycles. Increased dose intensity of chemotherapy adds toxicity without clear survival benefit. Appropriate supportive care (antiemetics, fluid support with cisplatin, monitoring of blood counts and blood chemistries, monitoring for signs of bleeding or infection, and, as required, use of hematopoietins) and adjustment of chemotherapy doses on the basis of nadir granulocyte counts are essential. The prognosis of patients who relapse is poor. Patients who relapse 3 months since the completion of their initial. | Chapter 085. Neoplasms of the Lung Part 17 Chemotherapy The chemotherapy combination most widely used for SCLC is etoposide plus cisplatin or carboplatin given every 3 weeks on an outpatient basis for four to six cycles. Increased dose intensity of chemotherapy adds toxicity without clear survival benefit. Appropriate supportive care antiemetics fluid support with cisplatin monitoring of blood counts and blood chemistries monitoring for signs of bleeding or infection and as required use of hematopoietins and adjustment of chemotherapy doses on the basis of nadir granulocyte counts are essential. The prognosis of patients who relapse is poor. Patients who relapse 3 months since the completion of their initial chemotherapy so-called chemosensitive disease have a median survival of 4-5 months patients who do not respond to initial chemotherapy or relapse within 3 months chemorefractory disease have a median survival of only 2-3 months. Patients with chemosensitive disease may be retreated with their initial regimen. Topotecan has modest activity as second-line therapy or patients can be entered onto clinical trials testing new agents. Considerations for Therapy of SCLC Limited-Stage Disease Combined-Modality Chemoradiotherapy Radiation therapy to the thorax is associated with a small but significant improvement in long-term survival for patients with limited-stage SCLC 5 at 3 years . Chemotherapy given concurrently with thoracic radiation is more effective than sequential chemoradiation but is associated with significantly more esophagitis and hematologic toxicity. In one randomized study twice-daily hyperfractionated radiation was compared with a once-daily schedule both were administered concurrently with four cycles of cisplatin and etoposide. Survival was significantly higher with the twice-daily regimen median survival 23 months compared with 19 months 5-year survival 26 compared with 16 but the twice-daily regimen gave more grade 3 esophagitis and pulmonary .