Sequential high-dose chemotherapy with autologous stem cell support in patients with limited-stage small cell lung cancer.

To determine the feasibility and safety of multiple sequential courses of high-dose chemotherapy with peripheral blood progenitor cells (PBSCs) followed by thoracic irradiation (54 Gy) and prophylactic cranial irradiation (PCI 30 Gy) in patients with limited disease (LD) small cell lung cancer (SCLC), six patients received one cycle of conventional-dose chemotherapy followed by four cycles of high-dose chemotherapy with stem cell support. Neither significant adverse side-effects nor treatment mortality were observed. CR and almost CR (> 90%) was obtained in five out of six patients while one patient had a partial response (PR). The median survival was 21.3 months (range 8-34). However, the benefit of the high CR rate and prolonged survival did not result in cure even in these favorable circumstances, because all the patients died of recurrence in the cerebral nervous system. According to our data we stopped this chemotherapy regime because it was not able to prevent cerebral disease.