Total lung irradiation and chemotherapy in pulmonary metastases from carcinoma of the uterine cervix and endometrium.

Despite the radiocurability of stage I and II squamous cell carcinoma (SCC) of the cervix, palliation of patients with pulmonary metastases has been disappointing. Four patients with pulmonary metastases (three from cervical and one from endometrial carcinoma) were treated with total lung irradiation, followed two to three weeks after termination of radiotherapy with combination chemotherapy consisting of vincristine 1.4 mg/m(2) IV+ adriamycin 50 mg/m(2) IV + cyclophosphamide 500 mg/m(2) IV repeated at four-week intervals. Radiotherapy was delivered through a Co(60) teletherapy unit in a daily dosage of 100 rads in anterior and posterior opposing fields. After completion of irradiation in one lung, the other lung was similarly treated if involved with gross disease. Two out of four patients (both with cervix SCC) obtained complete tumor regression, whereas the other two patients had stabilization of their pulmonary lesions. The survival of the two responders was 216+ and 621 days from the start of irradiation. The two nonresponders survived 56 and 109 days. Except for one patient who died of pulmonary metastases, the remaining three patients died of metastases elsewhere. While only one patient developed radiation pneumonitis, all four had alopecia and leukopenia <4000/mm(3) from chemotherapy. Total lung irradiation and combination chemotherapy appear to have activity in the treatment of pulmonary metastases from SCC of the cervix and warrant further exploration.