Adjuvant Chemotherapy for T1-2NOMO Small Cell Lung Cancer: Single-Agent or Combination Chemotherapy?

Abstract

In an attempt to address the schedule of adjuvant chemotherapy in surgically resected T1 or T2NOMO small cell lung cancer, 12 patients were randomized to receive 6 courses of either single-agent (high-dose epirubicin) or combination (cyclophosphamide, epirubicin, and etoposide) chemotherapy, at 3-week intervals. No thoracic radiotherapy was administered while prophylactic cranial irradiation (30 Gy/10 fractions/2 weeks) was given. With a 25-month median followup, overall estimated 2-year and median survival were 83% and 26.5 months (range 16–34⁺), respectively. Ten patients are currently alive and disease free. No significant difference in 2-year survival was observed between the two adjuvant treatment modalities and median survival was 28 months (range 13–34⁺) for combination and 21 months (range 14–29⁺) for single-agent chemotherapy. Although at high doses, epirubicin resulted in a moderate clinical and histological cardiotoxicity and a remarkably reduced incidence of severe (WHO grades 3 and 4) treatment-related morbidity compared with the combination regimen. These preliminary results suggest that comparable survival and reduced toxicity might be expected with an active single-agent as adjuvant chemotherapy in TI or T2NOMO small cell lung cancer.