Induction chemotherapy followed by concomitant chemo radiotherapy in patients with locally advanced non small cell lung cancer

Abstract EN

Between January 1996 and May 1997, 25 patients with stage III inoperable non-small cell lung cancer were planned to receive induction chemotherapy consisting of cisplatin (100 mg / m2 day 1) and etoposide (100 mg / m2 days 1-3), every 28 days for three cycles.

Patients responding to induction chemotherapy received concomitant chemoradiotherapy whereas non-responsive patients received the planned radiotherapy alone and / or palliative treatment.

Radiation dose was 50 Gy, delivered in 2 Gy daily fractions, over 5 weeks.

Concomitant chemotherapy consisted of cisplatin (15 mg / m2, days 1-5) and etoposide (50 mg / m2, days 1-5) given on weeks 1 and 4 of irradiation.

Response rate to induction chemotherapy was 60 % including 8 % complete response.

Toxicity (≥grade 3) of induction chemotherapy was mostly hematological (56 %).

Out of the 15 patients who received concomitant chemoradiotherapy, 8 had complete response and 5 had partial response.

Toxicity (≥grade 3) of concomitant chemoradiotherapy was mostly hematological (26.7%) and esophageal (20 %).

With a median follow-up of 17 months (range, 12-28), the estimated 1- and 2-year survival rates were 60 % and 35 %, respectively.

Median survival for all patients was 13 months.

Responding patients had a 2-year survival of 53 % compared to 10 % in non-responders (p < 0.01).

During follow-up, 17 of 25 patients (68 %) had disease progression : 5 local, 7 distant (5 in brain) and 5 had both.

Of the 15 patients who received concomitant chemoradiotherapy, 8 (53%) had disease progression (4 local, 2 distant and 2 both).

Four of 10 patients alive at the time of analysis without evidence of disease were complete responders to concomitant chemoradiotherapy.

This treatment approach was feasible with an acceptable toxicity, resulted in a high response rate and in a survival benefit for responsive patients.