[A comparison of systemic radiotherapy, chemotherapy or local radiotherapy in the treatment of extensive small-cell bronchial carcinoma. Results of a randomized series]. / Vergleich zwischen systemischer Strahlentherapie, Chemotherapie oder lokaler Strahlentherapie bei der Behandlung des ausgedehnten kleinzelligen Bronchialkarzinoms. Ergebnisse einer randomisierten Serie.

Between 1982 and 1987 we carried out a prospective randomized study to compare the effectiveness of high-dose half-body irradiation (HBI) (A), intensive combined chemotherapy (B), and local or locoregional radiotherapy (C) in the therapy of extended small cell lung carcinoma (SCLC). 99 patients with a histologically proved SCLC were assigned to the three therapeutic groups of series: A = 31 patients, B = 37 patients, C = 31 patients. The median survival period showed a statistically significant advantage (p less than 0.01) for the chemotherapy group (B = 46 weeks) versus the two radiotherapy groups (A = 19 weeks, C = 23 weeks). The survival after half a year, one year, and two years also gave a clear advantage for the chemotherapy group. No difference was found between the radiotherapy groups A and C. The high-dose HBI gave no improvement of the sad therapeutic situation for the extended SCLC.

A randomized clinical trial comparing systemic radiotherapy versus chemotherapy versus local radiotherapy in small cell lung cancer.

Between 1982 and 1987 a prospectively randomized trial of sequential hemibody irradiation (SHBI) (A), a non-cross-resistant chemotherapy drug combination (B) and local and/or locoregional radiotherapy (C) in small cell lung cancer (SCLC) was conducted. Previously untreated patients with extensive SCLC were randomized into three arms: A = 31 patients, B = 37, C = 31. In the chemotherapy combination, the following were used: etoposide, doxorubicin, methotrexate (VAM) and procarbacine, vincristine, cyclophosphamide, lomustine (POCC) and prophylactic cranial irradiation (30 Gy). The results show that the median survival was significantly (P less than 0.01) better in chemotherapy (44 weeks) compared with 17 and 20 weeks in arms A and C, respectively. One year and 2 year survival rates were better for the chemotherapy arm. No differences were found between groups A and C. In comparing the total hospitalization time expressed as a percentage of overall survival, an advantage for group B was shown. In conclusion, high dose SHBI cannot be recommended as a standard therapy for extensive SCLC.

[Use of CT in the staging and follow-up of small-cell bronchial cancer]. / Einsatz der CT beim Staging und Verlauf des kleinzelligen Bronchialkarzinoms.

In 54 patients with small-cell bronchial carcinoma, investigated with conventional X-ray technique and computer tomography, CT afforded a considerable extension of findings in regard to mediastinal tumor and metastatic spread, as well as in the detection of supraclavicular and pleural metastases. Also, the process of remission and renewed tumor growth could be observed better. Thus, CT constitutes quite an acquisition to therapy planning. The investigations carried out simultaneously in the brain region did not appreciably add to the findings in comparison to scintigraphy. In contrast, in the abdominal region, we have discovered liver metastases, subrenal metastases and lymph-node metastases both at first investigations and at controls. At post-mortem, however, we found kidney metastases that were not described in the CT but which may possibly have arisen prefinally. Altogether, thoracal and abdominal investigations with CT prior to onset of therapy and subsequent control are a valuable addition to therapy planning.

[Lymphocyte depletion after irradiation of the chest region dependent on irradiation technics]. / Lymphozytendepression bei Bestrahlung im Thoraxbereich in Abhängigkeit von der Bestrahlungstechnik.

In a prospective alternating study, the mediastinum of patients with bronchial carcinomas was preoperatively irradiated with 2000 cGy in ten fractions for an isodose of 80% by Co-60 stationary field or pendulum therapy. The leucocyte and lymphocyte blood count was determined every day. It was found out that the lymphocyte depression was significantly higher after pendulum therapy than after stationary field therapy. This is explained by the fact that the lymphocyte depression is caused rather by the irradiation of lymphocytes in the blood stream than by the irradiation of bone marrow.

[Treatment of inoperable small-cell bronchial carcinoma with local radiotherapy and supplementary high-dosage one-time upper and lower half-body irradiation]. / Zur Behandlung inoperabler kleinzelliger Bronchialkarzinome mit lokaler Strahlentherapie und zusätzlicher hochdosierter einzeitiger oberer und unterer Halbkörperbestrahlung.

37 patients with histologically verified inoperable small-cell bronchial carcinomas were treated with local tumor irradiation (40 Gy), combined with upper and lower half-body irradiation. Continuous analysis of the treatment results led to modification of therapy, from which two groups of patients resulted. In group I the whole-body treatment consisted of an irradiation of the upper, and six weeks later, of the lower half of the body with a dose of 8.8 Gy. In group 2 the half-body dose of 8.8 Gy was applied in 2 fractions on the same day (6.0 Gy, break of 5 hours, 2.0 Gy). The critical organ was the lung: the pneumonitis rate and the effect on tumor and metastases and survival times are reported.