Chemo-radiotherapy for stage III unresectable non-small cell lung cancer—long-term results of a prospective study

• Published in: Respiratory medicine Vol. 98; no. 11; pp. 1080 - 1086
• Main Authors: Leong, Swan Swan, Fong, Kam Weng, Ong, Yew Kwang, Foo, Kian Fong, Ang, Peter, Wee, Joseph, Lee, Khai Mun, Tan, Eng Huat
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-11-2004; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cancer therapies; Carboplatin - administration & dosage; Carboplatin - adverse effects; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - radiotherapy; Chemotherapy; Clinical trials; Combined Modality Therapy; Combined-modality; Disease control; Disease-Free Survival; Esophagitis; Esophagitis - etiology; Esophagus; Family medical history; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hematologic and hematopoietic diseases; Hematologic Diseases - etiology; Humans; Locally advanced; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - radiotherapy; Male; Medical imaging; Medical sciences; Middle Aged; Mortality; Neurotoxicity; Neutropenia; Other diseases. Hematologic involvement in other diseases; Other diseases. Semiology; Paclitaxel - administration & dosage; Paclitaxel - adverse effects; Pneumology; Prospective Studies; Radiation therapy; Survival Rate; Tomography; Treatment Outcome; Tumors of the respiratory system and mediastinum; Esophagitis; Neurotoxicity; Locally advanced; Combined-modality; Neutropenia; Lung disease; Prognosis; Leukopenia; Respiratory disease; Toxicity; Lung cancer; Esophageal disease; Nervous system; Hemopathy; Malignant tumor; non-small cell lung carcinoma; Radiotherapy; Long term; Prospective; Treatment; Unresectable; Digestive diseases; Bronchus disease; Non small cell carcinoma
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2004.03.020

Introduction: Combined-modality treatment is considered standard of care in the treatment of stage III non-small-cell lung cancer (NSCLC). This study was designed to assess the efficacy and tolerability of induction paclitaxel/carboplatin followed by concurrent thoracic radiotherapy and weekly paclitaxel.
Materials and methods: Patients with unresectable stage III NSCLC were treated prospectively with two cycles of paclitaxel (175
mg/m
2) and carboplatin (area under the curve of 6) followed by radiotherapy (60–66
Gy) concurrent with 6 weekly doses of paclitaxel (60
mg/m
2). Response was determined 8 weeks after the completion of treatment and treatment-related toxicities were assessed at each visit during treatment and follow-up.
Results: Sixty-three patients were treated, 5 had complete response and 33 had partial response, giving a response rate of 60%. Thirty-seven percent of patients developed grade 3 or 4 neutropenia; 48% had significant esophagitis requiring the use of narcotic analgesics. Two patients developed esophageal stricture subsequently. The median survival was 51 months and 12 months for stage IIIA and IIIB patients, respectively. Progression-free survival was 16months and 11months respectively.
Conclusions: The response rate was encouraging. Esophagitis was a significant morbidity and should prompt modification of treatment regimen, either in the chemotherapy schedule or by adjusting the radiotherapy treatment planning.