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. 1997;75(5):690–697. doi: 10.1038/bjc.1997.123

A phase III study of radiotherapy with and without continuous-infusion fluorouracil as palliation for non-small-cell lung cancer.

D Ball 1, J Smith 1, J Bishop 1, I Olver 1, S Davis 1, P O'Brien 1, D Bernshaw 1, G Ryan 1, M Millward 1
PMCID: PMC2063335  PMID: 9043026

Abstract

This study assesses the effect of adding continuous-infusion fluorouracil to palliative thoracic radiation therapy (RT) on the rate and duration of symptom relief in patients with advanced non-small-cell lung cancer (NSCLC). Two hundred eligible patients with NSCLC were randomized to receive either 20 Gy in five daily fractions as palliation for intrathoracic disease or the same RT with concurrent continuous infusion of 1 g m(-2) day(-1) fluorouracil for 5 days. Survival, response and rates of symptom relief in the two groups were compared according to treatment intent, and toxicities were compared according to treatment received. The overall response rate was higher in patients randomized to the combination (29%) than in patients randomized to RT alone (16%) (P = 0.035). However, there were no significant differences between the treatment arms in terms of overall or progression-free survival or in palliation of symptoms. Patients treated with RT plus fluorouracil had significantly more acute toxicity, including nausea and vomiting (P = 0.01), oesophagitis (P = 0.0003), stomatitis (P = 0.0005) and skin reaction (P = 0.003). This study suggests for the first time an interaction between RT and infusional fluorouracil in NSCLC. Although RT plus fluorouracil resulted in a significantly higher response rate than achieved with RT alone, this did not translate into more effective palliation. Because the combination produced significantly more toxicity than RT alone, it is not recommended for the palliative treatment of NSCLC. Nevertheless, these results suggest that opportunities may exist for exploitation of the observed enhancement of antitumour effect in the setting of high-dose radical RT for NSCLC.

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Selected References

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  1. Abratt R. P., Shepherd L. J., Salton D. G. Palliative radiation for stage 3 non-small cell lung cancer--a prospective study of two moderately high dose regimens. Lung Cancer. 1995 Oct;13(2):137–143. doi: 10.1016/0169-5002(95)00487-4. [DOI] [PubMed] [Google Scholar]
  2. Browman G. P., Cripps C., Hodson D. I., Eapen L., Sathya J., Levine M. N. Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol. 1994 Dec;12(12):2648–2653. doi: 10.1200/JCO.1994.12.12.2648. [DOI] [PubMed] [Google Scholar]
  3. Byfield J. E., Calabro-Jones P., Klisak I., Kulhanian F. Pharmacologic requirements for obtaining sensitization of human tumor cells in vitro to combined 5-Fluorouracil or ftorafur and X rays. Int J Radiat Oncol Biol Phys. 1982 Nov;8(11):1923–1933. doi: 10.1016/0360-3016(82)90451-5. [DOI] [PubMed] [Google Scholar]
  4. Carr D. T., Childs D. S., Jr, Lee R. E. Radiotherapy plus 5-FU compared to radiotherapy alone for inoperable and unresectable bronchogenic carcinoma. Cancer. 1972 Feb;29(2):375–380. doi: 10.1002/1097-0142(197202)29:2<375::aid-cncr2820290218>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  5. Citron M. L., Modeas C., Propert K., Goutsou M., Green M. R. Phase II trial of high-dose 24-hour continuous intravenous 5-fluorouracil for advanced non-small cell lung cancer: a Cancer and Leukemia Group B study. Cancer Invest. 1992;10(3):215–219. doi: 10.3109/07357909209032763. [DOI] [PubMed] [Google Scholar]
  6. Cummings B. J., Keane T. J., O'Sullivan B., Wong C. S., Catton C. N. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys. 1991 Oct;21(5):1115–1125. doi: 10.1016/0360-3016(91)90265-6. [DOI] [PubMed] [Google Scholar]
  7. Gelber R. D., Larson M., Borgelt B. B., Kramer S. Equivalence of radiation schedules for the palliative treatment of brain metastases in patients with favorable prognosis. Cancer. 1981 Oct 15;48(8):1749–1753. doi: 10.1002/1097-0142(19811015)48:8<1749::aid-cncr2820480810>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  8. HEIDELBERGER C., GRIESBACH L., MONTAG B. J., MOOREN D., CRUZ O., SCHNITZER R. J., GRUNBERG E. Studies on fluorinated pyrimidines. II. Effects on transplanted tumors. Cancer Res. 1958 Apr;18(3):305–317. [PubMed] [Google Scholar]
  9. Herskovic A., Martz K., al-Sarraf M., Leichman L., Brindle J., Vaitkevicius V., Cooper J., Byhardt R., Davis L., Emami B. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992 Jun 11;326(24):1593–1598. doi: 10.1056/NEJM199206113262403. [DOI] [PubMed] [Google Scholar]
  10. Kelly S. A., MacLeod P. M., Ash D. V. The use of simultaneous radiotherapy and 5-flurouracil in patients with inoperable squamous cell lung cancer. Clin Radiol. 1989 May;40(3):311–313. doi: 10.1016/s0009-9260(89)80219-3. [DOI] [PubMed] [Google Scholar]
  11. Lokich J., Chaffey J., Neptune W. Concomitant 5-fluorouracil infusion and high-dose radiation for stage III non-small cell lung cancer. Cancer. 1989 Sep 1;64(5):1021–1025. doi: 10.1002/1097-0142(19890901)64:5<1021::aid-cncr2820640509>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  12. O'Connell M. J., Martenson J. A., Wieand H. S., Krook J. E., Macdonald J. S., Haller D. G., Mayer R. J., Gunderson L. L., Rich T. A. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med. 1994 Aug 25;331(8):502–507. doi: 10.1056/NEJM199408253310803. [DOI] [PubMed] [Google Scholar]
  13. Perez C. A., Stanley K., Grundy G., Hanson W., Rubin P., Kramer S., Brady L. W., Marks J. E., Perez-Tamayo R., Brown G. S. Impact of irradiation technique and tumor extent in tumor control and survival of patients with unresectable non-oat cell carcinoma of the lung: report by the Radiation Therapy Oncology Group. Cancer. 1982 Sep 15;50(6):1091–1099. doi: 10.1002/1097-0142(19820915)50:6<1091::aid-cncr2820500612>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  14. Simpson J. R., Francis M. E., Perez-Tamayo R., Marks R. D., Rao D. V. Palliative radiotherapy for inoperable carcinoma of the lung: final report of a RTOG multi-institutional trial. Int J Radiat Oncol Biol Phys. 1985 Apr;11(4):751–758. doi: 10.1016/0360-3016(85)90307-4. [DOI] [PubMed] [Google Scholar]
  15. Slawson R. G., Scott R. M. Radiation therapy in bronchogenic carcinoma. Radiology. 1979 Jul;132(1):175–176. doi: 10.1148/132.1.175. [DOI] [PubMed] [Google Scholar]
  16. Tong D., Gillick L., Hendrickson F. R. The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group. Cancer. 1982 Sep 1;50(5):893–899. doi: 10.1002/1097-0142(19820901)50:5<893::aid-cncr2820500515>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]

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