Limited field radiotherapy concomitant with cisplatinetoposide followed by consolidation docetaxel for the treatment of inoperable stage III non-small cell lung cancer

Abstract EN

Purpose : To evaluate the efficacy and outcome of concomitant cisplatin/etoposide and limited field irradiation followed by consolidation docetaxel in patients with locally advanced non small cell lung cancer (NSCLC). Patients and Methods: This is a prospective phase II study that included 32 patients with locally advanced stage III NSCLC who presented to the Radiation Oncology and Chest Departments- Ain Shams University hospitals, and Sohag Cancer Center between May 2004 and August 2006. Eligible patients were treated first with two cycles of cisplatin 50mg/m2/day on days 1, 8, 29 and 36 and etoposide 50mg/m2/day on days 1-5 and 29-33 concomitant with conventionally fractionated radiation (66Gy in 2Gy fractions) to the gross primary disease and regionally involved lymph nodes followed by 3 cycles of consolidation single agent docetaxel, 75mg/m2/3 weeks. Results: The median follow-up duration was 13.5 months (range from 6 to 30 months).

The median survival was 17.4 months and the median progression free survival was 13 months.

A total of 20 patients (62.5%) had treatment failure, 47% had an in field failure, 44% had distant failure, and one patient (3%) had isolated nodal failure (INF). Neutropenia (15.5%), anemia (19%), nausea and vomiting (15.5), esophagitis (9%) and pneumonitis (3%) were the most severe, grade 3 and 4, acute toxicities recorded during concomitant chemoradiation and 3 patients (9%) had grade 3 late esophagitis.

Neutropenia (35%) and anemia (17%) were the most pronounced, grade 3 and 4, toxicities during consolidation chemotherapy. Conclusion: Concomitant chemoradiation, without elective nodal irradiation (ENI), is a promising approach for management of locally advanced NSCLC.

Conformal irradiation with possible dose escalation may provide an opportunity for more improvement of the therapeutic ratio. The addition of consolidation docetaxel is still questionable and needs more investigation.