Tumour response and radiation-induced lung injury in patients with recurrent small cell lung cancer treated with radiotherapy and concomitant interferon-alpha

Lung Cancer. 1999 Jan;23(1):39-52. doi: 10.1016/s0169-5002(98)00092-0.


The aim of this study was to determine whether either natural or recombinant interferon (IFN)-alpha can improve the response to radiotherapy (RT) in patients with small cell lung cancer (SCLC), and to assess the role of IFN in radiation-induced lung injury. All patients had previously participated in a randomised trial of chemotherapy alone or in combination with IFN-alpha in three arms (arm O: no IFN, arm I: natural IFN-alpha, arm II: recombinant IFN-alpha). Patients with locally progressive disease in the lungs following chemotherapy were treated with RT and they continued with their concomitant IFN-alpha. The RT dose was 50 Gy. Radiation-induced lung injury was assessed by lung function tests, computed tomography and bronchoalveolar lavage fluid (BALF) analysis which included cell findings, Interleukin (IL)-1 alpha/-1 beta expression by alveolar macrophages and surfactant components. Seventeen patients were entered in the study, 16 of whom were evaluable. Response rates in Arms O, I and II were 50, 67 and 50%, respectively. Median survival was 18.5, 7 and 23 months respectively, and 1-year survival was 67, 29 and 75% respectively. Long-term survival as assessed by 2- and 3-year survival rates was 29% in patients receiving natural IFN-alpha as compared to 17% in patients not receiving IFN (not statistically significant findings). Every patient had abnormal results when assessed for radiation-induced lung injury. No statistically significant difference was found in toxicity between the treatment arms. A high surfactant protein (SP)-A/phospholipid ratio and a high level of SP-A in BALF before RT was associated with a high degree of radiation-induced lung injury measured by lung function tests and computed tomography in all arms of the study. Thus, we could not show that the combination of IFN-alpha and RT induced more lung toxicity than RT alone as we did in our previous study. The role of high SP-A/phospholipid ratios and high SP-A levels in BALF before RT as predictors of the development of lung injury after RT needs to be determined in the future.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use*
  • Bronchoalveolar Lavage Fluid / cytology
  • Carcinoma, Small Cell / drug therapy
  • Carcinoma, Small Cell / pathology
  • Carcinoma, Small Cell / radiotherapy*
  • Cell Count
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Glycoproteins / metabolism
  • Humans
  • Interferon Type I / therapeutic use*
  • Interleukin-1 / metabolism
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Macrophages, Alveolar / pathology
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Proteolipids / metabolism
  • Pulmonary Surfactant-Associated Protein A
  • Pulmonary Surfactant-Associated Proteins
  • Pulmonary Surfactants / metabolism
  • Radiation Pneumonitis / diagnosis
  • Radiation Pneumonitis / etiology*
  • Radiation Pneumonitis / metabolism
  • Radiotherapy / adverse effects
  • Recombinant Proteins
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Treatment Outcome


  • Antineoplastic Agents
  • Glycoproteins
  • Interferon Type I
  • Interleukin-1
  • Proteolipids
  • Pulmonary Surfactant-Associated Protein A
  • Pulmonary Surfactant-Associated Proteins
  • Pulmonary Surfactants
  • Recombinant Proteins