Combined alkylators and multiple-site irradiation for extensive XXXX : a Southwest Oncology Group Study.

@entity1 @entity632 @entity882 @entity11678 @entity786 @entity3600 @entity1891 @entity3 @entity151 @entity3028 @entity3895
The Southwest Oncology Group performed a study for @entity1 with extensive @entity151 in which two hypotheses were tested: that combined alkylating agents for induction might improve the initial response rate; and that multiple-site, involved-field consolidation with irradiation in @entity1 with response to chemotherapy might further improve response quality and duration. A regimen of combined alkylating agents plus @entity1891 [ @entity3600 , @entity11678 , @entity1891 , and @entity786 (BTOC)] was compared to our standard program of @entity786 , @entity632 , and @entity1891 ( @entity3895 ). @entity1 with bone marrow @entity3 and/or disseminated bone @entity3 were randomized to BTOC or @entity3895 as initial induction therapy, but received no multiple-field irradiation afterward. Among 189 such @entity1 , the overall response rates were similar (48% to BTOC and 61% to @entity3895 , with complete remission in 5% and 15%, respectively). Toxic effects were also comparative, with 23% sustaining life-threatening or fatal complications on BTOC and 16% on @entity3895 . Median survival (5.9 and 7 months for BTOC and @entity3895 , respectively) and overall survival were not different, and are superimposable upon our previously reported results with @entity3895 alone. For @entity1 with no evidence of bone marrow involvement and no @entity3 identified beyond the confines of ipsilateral hemithorax, liver, and brain, the plan of therapy consisted of induction chemotherapy (BTOC or @entity3895 ) every 3 weeks for three cycles, followed by multiple-field irradiation consolidation to sites of prior involvement. Among 239 such @entity1 , response rates to therapy initiated with BTOC and @entity3895 were also similar: 54% for BTOC and 62% for @entity3895 , with complete response in 16% and 13%, respectively. However, the program of BTOC followed by multiple-site irradiation was associated with a higher incidence of severe or life-threatening @entity882 (23% versus 8% for @entity3895 ), accounted for almost entirely by @entity1 receiving hepatic irradiation after chemotherapy, among whom the incidence of this complication (grade 3 or 4) was 76% and 14%, respectively. Other toxic effects, including @entity3028 , were comparable. With the exception of @entity882 in the cited subgroup, multiple-field irradiation consolidation proved feasible and tolerable, with improved quality of response evident after its initiation in 24% of 135 @entity1 . However, a similar proportion developed disease progression during or shortly after radiation therapy, and the median survival of @entity1 who received irradiation was only 9 months (7 months from the start of consolidation).(ABSTRACT TRUNCATED AT 400 WORDS)
