Multiagent chemotherapy, prophylactic neuraxis irradiation, and consolidative irradiation for small cell XXXX .

@entity1 @entity632 @entity295 @entity66 @entity2 @entity786 @entity4681 @entity1891 @entity3 @entity360 @entity3895
Between 6/81 and 6/83, 73 @entity1 with small cell @entity2 were treated according to a prospective protocol in which @entity786 , @entity632 , and @entity1891 ( @entity3895 ) were given concurrently with prophylactic craniocervical irradiation to the level of C5. Both limited and @entity66 @entity1 with normal computed tomography of the brain received 25 Gy in 10 fractions in 2 weeks. Complete responders to @entity3895 received consolidative thoracic irradiation (CTI) to the local-regional primary (37.5 Gy in 15 fractions in 3 weeks), the first 25 Gy in 10 fractions serving as prophylaxis of the C6 to T12 spinal cord. The neuraxis from L1 to S2 then received 25 Gy in 10 fractions in 2 weeks. Consolidative irradiation of localizable metastatic sites was given in @entity66 @entity1 . Partial and nonresponders to @entity3895 received 50-60 Gy in 5-6 weeks to local-regional disease. With a median followup of 29 months, survival was significantly better (p less than .01) in @entity1 receiving CTI to the chest after complete response to @entity3895 (both limited disease and @entity66 ) than without CTI. Of 41 @entity1 completing the protocol and without central nervous system (CNS) involvement at presentation, four (9%) failed initially in the CNS (two brain, two @entity4681 ); CNS failure was the cause of death in all four @entity1 with no other sites of @entity3 at death in two of these. Failure to complete protocol treatment was due to disease progression during chemotherapy in 25/73 (34%) and chemotherapy related complications (three @entity295 , one @entity360 ) in four of 73 (5.5%) @entity1 . CTI and prophylactic neuraxis irradiation did not increase morbidity or result in mortality in the sequence utilized; prophylactic neuraxis irradiation appears to reduce the CNS relapse rate, and CTI benefits survival.
