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Elias et al.
partial purge of the autograft, and the ability to deliver early dose-intensive thoracic
radiotherapy. The drawback of later administration of the dose-intense cycle can be
surmounted in part by intensification and shortening of induction chemoradio-
therapy. The optimum may be to merge the two strategies into one: a brief dose
intensive induction followed by a single or double cycle of stem cell supported
therapy followed by TRT and PCI. Ultimately, a randomized trial in patients with
limited comorbid disease will be necessary to determine whether the increased
toxicity is worthwhile and for which subsets of patients this approach is curative.
High-dose therapy has a strong scientific basis: it kills more tumor cells and
achieves minimal tumor burden in most. In clinical situations in which toxicity has
been acceptable, it typically results in prolonged progression-free survival in a
subset of patients. An additional group of patients may be near-cure. High-dose
therapy may have increased value if additional targets of residual tumor cells can
be identified for novel treatment strategies and modalities. Most biologic strategies
such as active or adoptive immunotherapy, gene function replacement
(retinoblastoma gene and/or p53), or interruption of autocrine or paracrine growth
loops work best against minimal tumor burden.
ACKNOWLEDGMENTS
Supported in part by a grant from the Public Health Service, grant CAI 3849
from the National Cancer Institute, National Institutes of Health, Department of
Health and Human Services.
REFERENCES
1. Boring CC, Squires TS, Tong IT: Cancer Statistics, 1993. CA—A Cancer Journal for
Clinicians 44:19-51, 1994.
2. Johnson DH, Kim K, Sause W, et al.: Cisplatin and etoposide plus thoracic radiotherapy
administered once or twice daily in limited stage small cell lung cancer: Final report of
intergroup trial 0096. ProcASCO 15:374, 1996.
3. Seifter EJ, Ihde DC: Therapy of small cell lung cancer: A perspective on two decades of
clinical research. Semin Oncol 15:278-299,1988.
4. Osterlind K, Hansen HH, Hansen M, Dombernowsky P, Andersen PK: Long-term dis­
ease-free survival in small cell carcinoma of the lung: A study of clinical determinants.
J Clin Oncol 4:1307-1313, 1986.
5. Teicher B A: Preclinical models for high-dose therapy. In: Armitage JO, Antman KH (eds)
High-Dose Cancer Therapy: Pharmacology, Hematopoietins, Stem Cells. Baltimore:
Williams and Wilkins, 1992, p. 14-42.
6. Frei E III: Combination cancer chemotherapy: Presidential address. Cancer Res
32:2593-2607, 1972.
7. Frei E III, Canellos GP: Dose, a critical factor in cancer chemotherapy. Am J Med
409