Lung cancer treatment with high cyclophosphamide doses versus high cyclophosphamide doses plus radiotherapy

Sixty-six evaluable male patients with a histologically proved inoperable lung cancer, with a Karnofsky's score greater than or equal to 30, were considered for study. The mean age was 57.2 (range 20 to 74) years. Tumor cell types were of epidermoid carcinoma 50, adenocarcinoma 6, undifferentiated small cell carcinoma 5, and undifferentiated large cell carcinoma 5. Fifty patients had limited disease and 15 had extensive disease. They were treated with combined modality therapy Cyclophosphamide (CY) 50 mg/kg body weight, administered into the tubing of a freely running intravenous infusion of 5% dextrose every 10 to 12 days, followed by radiation therapy with 60Co, 6000 rad and then, with CY 17 mg/kg body weight every 15 days until progression (Ch-R-Ch group). The control group (Ch) of 31 patients was treated with CY 50 mg/kg body every 10/12 days. Complete response was achieved in 3/35 patients and partial response in 15/35 patients of the Ch-R-Ch group. In the control group, 12/31 patients achieved partial response. Total dose of CY was higher in responders achieving a significantly longer survival (median 12+ months) in comparison to non-responders (median 7 months) and the control group (median 6 months). Less toxic reactions were seen in patients responding to Ch-R-Ch regimen. Bone marrow depletion did not affect the patient's survival, but cystitis and alopecia, it appeared, decreased life expectancy. It is concluded that combined modality therapy is better than chemotherapy alone, with less cytotoxicity in responders