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Lung cancer: A review of current therapeutic modalities

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Abstract

This article describes the current approach to the systematic management of both small cell and non-small cell lung cancer (NSCLC). The treatment of stages I, II, and IIIa NSCLC is surgical resection. Although adjuvant chemotherapy in stage I disease offers no survival benefit, the role of adjuvant chemotherapy in stage II and IIIa NSCLC remains controversial. Results of pilot studies using neoadjuvant chemotherapy in stage IIIa NSCLC are encouraging and data from ongoing randomized trials are awaited with interest. For locally advanced NSCLC, chest irradiation remains the standard of care. However, the addition of systemic chemotherapy holds promise. The impact of cisplatin-based regimens on overall survival in stage IV NSCLC remains disappointing. The introduction of newer agents, such as 7-ethyl-10-[4-(1-piperidino)-1-piperidino] carbonyloxycamptothecin (CPT-11), a topoisomerase-I inhibitor, has shown early favorable results.

Chemotherapy is the most important therapeutic modality in the management of small cell lung cancer because of this cancer's propensity for early dissemination. In limited stage small cell lung cancer, chest radiotherapy, particularly if used early and concurrently with chemotherapy, may improve survival, but at the expense of increased toxicity. The role of prophylactic brain irradiation remains controversial in limited-stage disease. Chemotherapy is also the most important treatment modality in extensive-stage disease, but its role is only palliative. Radiotherapy is reserved primarily for disease-related complications in patients in whom chemotherapy has failed.

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References

  1. Armstrong J, Minsky B (1989) Radiation therapy for medically inoperable stage I and II nonsmall cell lung cancer. Cancer Treat Rev 16:247–255

    Google Scholar 

  2. Bangma PJ (1972) Postoperative radiotherapy. In Deeley TJ (ed) Carcinoma of the bronchus: modern radiotherapy. Appleton-Century-Crofts, New York, pp 163–170

    Google Scholar 

  3. Boring CC, Squires TS, Tong T (1992) Cancer statistics, 1992. CA-A 42:19–39

    Google Scholar 

  4. Brunner KW, Marthaler T, Muller W (1973) Effects of long-term adjuvant chemotherapy with cyclophosphamide NSC-26271 for radically resected bronchogenic carcinoma. Cancer Chemother Rep 4:125–132

    Google Scholar 

  5. Bunn PA, Lichter AS, Makuch RW, et al. (1987) Chemotherapy alone or chemotherapy with radiation therapy in limited stage small cell lung cancer. Ann Int Med 106:655–662

    Google Scholar 

  6. Cellerino R, Tummarello D, Guidi F, et al. (1991) A randomized trial of alternating chemotherapy versus best supportive care in advanced non-small cell lung cancer. J Clin Oncol 9:1453–1461

    Google Scholar 

  7. Cullen J, McKenna J, Massey M (1986) International control of smoking and the U.S. experience. Chest 89 (suppl 4):2206S-2218S

    Google Scholar 

  8. Dillman RO, Seagren SL, Propert KJ, et al. (1990) A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med 323:940–945

    Google Scholar 

  9. Einhorn L, Loehrer P, Williams S, et al. (1986) Random prospective study of vindesine versus vindesine plus high-dose cisplatin versus vindesine plus cisplatin plus mitomycin C. J Clin Oncol 4:1037–1043

    Google Scholar 

  10. Einhorn LFI, Crawford J, Birch R, et al. (1988) Cisplatin plus etoposide consolidation following cyclophosphamide, doxorubicin, and vincristine in limited small-cell lung cancer. J Clin Oncol 6:451–456

    Google Scholar 

  11. Elliott J, Ahmedzal S, Hole D, et al. (1984) Vindesine and cisplatin combination chemotherapy compared with vindesine as a single agent in the management of non-small cell lung cancer: a randomized study. Eur J Cancer Clin Oncol 20:1025–1032

    Google Scholar 

  12. Emami B, Perez CA (1992) Lung. In Perez CA, Brady, LW (eds) Principles and practice of radiation oncology, 2nd ed. Philadelphia, JB Lippincott, pp 806–836

    Google Scholar 

  13. Evans WK, Feld R, Murray N, et al. (1987) Superiority of alternating non-cross-resistant chemotherapy in extensive small cell lung cancer. Ann Intern Med 107:451–458

    Google Scholar 

  14. Fleck JF, Einhorn LH, Lauer RC, et al. (1990) Is prophylactic cranial irradiation indicated in small-cell lung cancer? J Clin Oncol 8:209–214

    Google Scholar 

  15. Fossella FV, Ryan B, Dhingra H, et al. (1991) Interim report of a prospective randomized trial of neoadjuvant chemotherapy plus surgery versus surgery alone for IIIa non-small cell lung cancer. Proc Am Soc Clin Oncol 10 (abstract):240

    Google Scholar 

  16. Fox W, Scadding JG (1973) Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus. Lancet 2:63–65

    Google Scholar 

  17. Frytak S, Shaw E, Eagan R (1991) Accelerated hyperfractionated split-course thoracic radiotherapy and infusion cisplatin for small cell lung cancer. Proc Am Soc Clin Oncol 10 (abstract): 260

    Google Scholar 

  18. Fukuoka M, Furuse K, Saijo N, et al. (1991) Randomized trial of cyclophosphamide, doxorubicin, and vincristine versus cisplatin and etoposide versus alternation of these regimens in small-cell lung cancer. J Natl Cancer Inst 83:855–861

    Google Scholar 

  19. Fukuoka M, Nitani H, Suzuki A, et al. (1992) A phase II study of CPT-11, a new derivative of camptothecin, for previously untreated non-small cell lung cancer. J Clin Oncol 10:16–20

    Google Scholar 

  20. Ganz P, Figlin R, Haskell C, et al. (1989) Supportive care versus supportive care and combination chemotherapy in metastatic non-small cell lung cancer. Cancer 63:1271–1278

    Google Scholar 

  21. Gomez-Codina J, Rosell R, Camps C, et al. (1991) Effective neoadjuvant chemotherapy for stage IIia non-small cell lung cancer—a randomized trial of preoperative MIC chemotherapy in comparison with immediate surgery. Sixth European Conference on Clinical Oncology and Cancer Nursing Firenze (abstract):S167

  22. Greco FA, Perez C, Einhorn LH, et al. (1986) Combination chemotherapy with or without concurrent thoracic radiotherapy in limited stage small cell lung cancer: a phase III trial of the Southeastern Oncology Group. Proc Am Soc Clin Oncol 5 (abstract):178

    Google Scholar 

  23. Haffty B, Goldberg N, Gerstley J, et al. (1988) Results of radical radiation therapy in clinical stage I, technically operable non-small cell lung cancer, Int J Radiat Oncol Biol Phys 15:69–73

    Google Scholar 

  24. Haffty BG (1990) Is radiation therapy a viable alternative to surgery in early stage lung cancer? Int J Radiat Oncol Biol Phys 19:223–224

    Google Scholar 

  25. Herskovic AM, Orton CG (1986) Editorial: elective brain irradiation for small cell anaplastic lung cancer. Int J Radial Oncol Biol Phys 12:427–429

    Google Scholar 

  26. Holmes EC (1988) Current status of adjuvant chemotherapy in the treatment of non-small cell lung cancer. In DeVita VT, Heilman, Rosenberg (eds) Important advances in oncology. Philadelphia, JB Lippincott, pp 259–272

    Google Scholar 

  27. Holmes EC, Gail M, Lung Cancer Study Group (1986) Surgical adjuvant therapy for stage II and stage III adenocarcinoma and large-cell undifferentiated carcinoma. J Clin Oncol 4:710–715

    Google Scholar 

  28. Holoye PY, McMurtrey MJ, Mountain CF, et al. (1990) The role of adjuvant surgery in the combined modality therapy of small cell bronchogenic carcinoma after a chemotherapy-induced remission. J Clin Oncol 8:416–422

    Google Scholar 

  29. Ihde DC, Minna JD (1991) Non-small cell lung cancer. Part II: Treatment. Curr Probl Cancer 15:109–154

    Google Scholar 

  30. Israel L, Bonmadonna G, Sylvester R, et al. (1979) Lung cancer. In Rozencweig M, Muggia F (ed) Progress in therapeutic research. Raven Press, New York, pp 443–452

    Google Scholar 

  31. Johnson BE, Becker B, II GWB, et al. (1985) Neurologic, neuropsychologic, and computed cranial tomography scan abnormalities in 2- to 10-year survivors of small-cell lung cancer. J Clin Oncol 3:1659–1667

    Google Scholar 

  32. Johnson BE, Salem C, Nesbitt J, et al. (1991) Limited stage small cell lung cancer treated with concurrent bid chest radiotherapy and etoposide/cisplatin followed by chemotherapy selected by in vitro drug sensitivity testing. Proc Am Soc Clin Oncol 10 (abstract):240

    Google Scholar 

  33. Kaasa S, Thorud E, Host H, et al. (1988) A randomized study evaluating radiotherapy versus chemotherapy in patients with inoperable non-small cell lung cancer. Radiat Oncol 11:713

    Google Scholar 

  34. Kies MS, Mira JG, Crowley JJ, et al. (1987) Multimodal therapy for limited small-cell lung cancer: a randomized study of induction combination chemotherapy with or without thoracic radiation in complete responders; and with wide-field versus reduced-field radiation in partial responders: a Southwest Oncology Group Study. J Clin Oncol 5:592–600

    Google Scholar 

  35. Kristjansen PEG, Hansen HH. (1990) Management of small cell lung cancer: a summary of the third international association for the study of lung cancer workshop on small cell lung cancer. J Natl Cancer Inst 82:263–266

    Google Scholar 

  36. Krook J, Fleming T, Eagan R, et al. (1984) Comparison of combination chemotherapy programs in advanced adenocarcinoma-large cell carcinoma or the lung: a North Central Cancer Treatment Group study. Cancer Treat Rep 68:493–498

    Google Scholar 

  37. LeChevalier T, Arriagada R, Quoix E, et al. (1991) Chemotherapy adds benefit to radiation for patients with locally advanced non-small cell lung carcinoma: results of a randomized study in 353 patients. Proc Am Soc Clin Oncol 10 (abstract):245

    Google Scholar 

  38. LeChevalier T, Arriagada R, Quoix E, et al. (1991) Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: first analysis of a randomized trial in 353 patients. J Natl Cancer Inst 83:417–423

    Google Scholar 

  39. LeChevalier T, Arriagada R, Tarayre M, et al. (1992) Significant effect of adjuvant chemotherapy on survival in locally advanced non-small-cell lung cancer. J Natl Cancer Inst 84:58 (letter)

    Google Scholar 

  40. Lee JS, Murphy WK, Glisson BS, et al. (1989) Primary chemotherapy of brain metastasis in small-cell lung cancer. J Clin Oncol 7:916–922

    Google Scholar 

  41. Luedke D, Einhorn L, Omura G, et al. (1990) Randomized comparison comparison of two combination regimens versus minimal chemotherapy in non-small cell lung cancer: a Southeastern Cancer Study Group trial. J Clin Oncol 8:886–891

    Google Scholar 

  42. Lung Cancer Study Group (1986) Effects of postoperative mediastinal radiation on completely resected stage II and stage III epidermoid cancer of the lung. N Eng J Med 315:1377–1381

    Google Scholar 

  43. Lung Cancer Study Group (1988) The benefit of adjuvant treatment for resected locally advanced non-small cell lung cancer. J Clin Oncol 6:9–17

    Google Scholar 

  44. Martini N, Kris MG, Gralla R, et al. (1988) The effects of preoperative chemotherapy on the resectability of non-small cell lung carcinoma with mediastinal lumph node metastasis (N2M0). Ann Thorac Surg 45:370–379

    Google Scholar 

  45. Mattson K, Holsti LR, Holsti P, et al. (1988) Inoperable non-small cell lung cancer: radiation with or without chemotherapy. Eur J Cancer Clin Oncol 24:477–482

    Google Scholar 

  46. Mountain CF (1985) The biological operability of stage III non-small cell lung cancer. Ann Thorac Surg 40:60–64

    Google Scholar 

  47. Mountain CF (1986) A new international staging system for lung cancer. Chest 89:225S-233S

    Google Scholar 

  48. Mountain CF, Lukeman JM, Hammar SP, et al. (1987) Lung cancer classification: the relationship of disease extent and cell type to survival in a clinical trials population. J Surg Oncol 35:147–156

    Google Scholar 

  49. Murray N, Coy P, Pater J (1991) The importance of timing for thoracic irradiation in the combined modality treatment of limited stage small cell lung cancer. Proc Am Soc Clin Oncol 10 (abstract):243

    Google Scholar 

  50. Murren JR, Buzaid AC, Hait WN (1991) Critical analysis of neoadjuvant therapy for stage IIIa non-small cell lung cancer. Am Rev Respir Dis 143:889–894

    Google Scholar 

  51. Neill H, Griffin J, Hunter R, et al. (1989) Combination versus sequential single-agent chemotherapy in the treatment of patients with advanced non-small cell lung cancer. Med Pediatr Oncol 17:69–75

    Google Scholar 

  52. Osterlind K, Hansen HH, Hansen HS, et al. (1986) Chemotherapy versus chemotherapy plus irradiation in limited stage small cell lung cancer. Results of a controlled trial with 5 years follow-up. Br J Cancer 54:7–17

    Google Scholar 

  53. Patterson R, Russell MH (1962) Clinical trials in malignant disease. IV. Lung cancer. Value of postoperative radiotherapy. Clin Radiol 13:141–144

    Google Scholar 

  54. Perez CA, Einhorn L, Oldham RK, et al. (1984) Randomized trial of radiotherapy to the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report. J Clin Oncol 2:1200–1208

    Google Scholar 

  55. Perry MC, Eaton WL, Propert KJ, et al. (1987) Chemotherapy with or without radiation therapy in limited stage small-cell carcinoma of the lung. N Engl J Med 316:912–918

    Google Scholar 

  56. Quoix E, Dietemann A, Charbonneau J, et al. (1991) Is chemotherapy with cisplatin useful in non-small cell bronchial cancer at staging IV? Results of a randomized study. Bull Cancer (Paris) 78:341–346

    Google Scholar 

  57. Rapp E, Pater JL, Willan A, et al. (1988) Chemotherapy can prolong survival in patients with advanced non-small-cell lung cancer-report of a Canadian multicenter randomized trial. J Clin Oncol 6:633–641

    Google Scholar 

  58. Rosso R, Salvati F, Ardizzoni A, et al. (1990) Etoposide versus etoposide plus high-dose cisplatin in the management of advanced non-small cell lung cancer: results of a prospective randomized FONICAP trial. Cancer 65:130–134

    Google Scholar 

  59. Roth BJ, Johnson DH, Einhorn LH, et al. (1992) Randomized study of cyclophosphamide, doxorubicin, and vincristine versus etoposide and cisplatin versus alternation of these two regimens in extensive small-cell lung cancer: a phase III trial of the Southeastern Cancer Study Group. J Clin Oncol 10:282–291

    Google Scholar 

  60. Ruckdeschel J. Personal communication.

  61. Sandler HM, Curran WJ Jr, Turrisi AT III (1990) The influence of tumor size and pre-treatment staging on outcome following radiation therapy alone for stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 19:9–13

    Google Scholar 

  62. Schaake-Koning C, Bogaert W van den, Dalesio O, et al. (1992) Effects of concommittant cisplatin and radiotherapy on inoperable non-small-cell lung cancer. N Engl J Med 326:524–530

    Google Scholar 

  63. Shepard FA, Ginsberg RJ, Feld R, et al. (1991) Surgical treatment for limited small cell lung cancer. The University of Toronto Lung Oncology Group experience. J Thorac Cardiovas Surg 101:385–393

    Google Scholar 

  64. Shepherd FA, Evans WK, Feld R, et al. (1988) Adjuvant chemotherapy following surgical resection for small cell carcinoma of the lung. J Clin Oncol 6:832–838

    Google Scholar 

  65. Shields TM, Higgins GA, Humphrey EW, et al. (1982) Prolonged intermittent adjuvant chemotherapy with CCNU and hydroxyurea after resection of carcinoma of the lung. Cancer 50:1713–1721

    Google Scholar 

  66. Shields TM, Robinette CD, Keehn MS (1974) Bronchial carcinoma treated by adjuvant cancer chemotherapy. Arch Surg 109:329–333

    Google Scholar 

  67. Shields TW, Higgins GAJ, Matthews MJ, et al. (1982) Surgical resection in the management of small cell carcinoma of the lung. J Thorac Cardiovasc Surg 84:481–488

    Google Scholar 

  68. Slack HH (1970) Bronchogenic carcinoma: nitrogen mustard as a surgical adjunct and factors influencing survival. University Surgical Adjuvant Lung Cancer Project. Cancer 25:987–1002

    Google Scholar 

  69. Souhami RL, Geddes DM, Spiro SG, et al. (1984) Radiotherapy in small cell cancer of the lung treated with combination chemotherapy: a controlled trial. Br Med J 288:1643–1646

    Google Scholar 

  70. Talton BM, Constable WC, Kersh CR (1990) Curative radiotherapy in non-small cell carcinoma of the lung. Int J Radiat Oncol Biol Phys 19:15–21

    Google Scholar 

  71. Turrisi AT, Glover DJ, Mason BA, et al. (1989) Prophylactic cranial irradiation after chemotherapy as part of a combined modality platinum-etoposide and twice-daily chest radiotherapy for limited small cell lung cancer. Proc Am Soc Clin Oncol 8 (abstract):245

    Google Scholar 

  72. Turrisi ATI, Glover DJ, Mason BA (1988) A preliminary report: concurrent twice-daily radiotherapy plus platinum-etoposide chemotherapy for limited small cell lung cancer. Int J Radiat Oncol Biol Phys 15:183–187

    Google Scholar 

  73. Twelves CJ, Souhami RL, Harper PG, et al. (1990) The response of cerebral metastases in small cell lung cancer to systemic chemotherapy. Br J Cancer 61:147–150

    Google Scholar 

  74. VanHoutte P, Rocmans R, Smets P, et al. (1980) Post-operative radiation therapy in lung cancer: a controlled trial after resection of curative design. Int J Radiat Oncol Biol Phys 6:983–985

    Google Scholar 

  75. Woods R, Williams C, Levitt J, et al. (1990) A randomized trial of cisplatin and vindesine versus supportive car only in advanced non-small cell lung cancer. Br J Cancer 61:608–611

    Google Scholar 

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  1. Section of Medical Oncology, Yale University School of Medicine, 333 Cedar Street, P.O. Box 3333, 06510, New Haven, CT, USA

    Alan B. Sandler & Antonio C. Buzaid

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Sandler, A.B., Buzaid, A.C. Lung cancer: A review of current therapeutic modalities. Lung 170, 249–265 (1992). https://doi.org/10.1007/BF00566678

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