FEASIBILITY OF ESCALATING DAILY DOSES OF CISPLATIN IN COMBINATION WITH ACCELERATED RADIOTHERAPY IN NONSMALL CELL LUNG-CANCER

The aim of this study was to determine whether it is feasible to reduc e the overall treatment time from 7 to 4 weeks in patients with non-sm all cell lung cancer (NSCLC) receiving radiotherapy with cisplatin. Th is follows an EORTC phase III randomised trial (08844) in which cispla tin given before each radiation dose resulted in improved local contro l and survival, but which had a relatively long treatment period of 7 weeks [Schaake-Koning et al., N Eng J Med 1992, 326, 524-530]. 38 pati ents with confirmed NSCLC (2 stage I, 1 stage II, 18 stage IIIA, 17 st age IIIB) received a total tumour dose of 55 Gy/20 fractions/26 days, from January 1992 to March 1994. Daily fractions of 2 Gy (5 times/week ) were given to the macroscopic tumour and the non-involved adjacent l ymph node areas. During the same session, a dose of 0.75 Gy was given to the macroscopic tumour (simultaneous boost). Cisplatin 6 mg/m(2) wa s administered 1-2 h before each fraction, in an escalating total dose , during week 1 in 3 patients, during weeks 1 and 2 in 6 patients, dur ing weeks 1, 2 and 3 in 5 patients and during the whole treatment in 2 4 patients. 38 patients were evaluable for acute side-effects (WHO). M aximal therapy-related toxicity (WHO) was grade 3 (nausea/vomiting in 2 patients, oesophagitis in 3 patients, dyspnoea in 3 patients, cough in 1 patient). Late side-effects were evaluated in 34 patients. There was grade 2 oesophagitis in 2 patients; grade 3 toxicity in 8 patients (tiredness in 3 patients, dyspnoea in 3 patients, oesophagitis in 2 p atients); grade 4 toxicity in 4 patients (dyspnoea in 3 patients, coug h in 1 patient). Pulmonary fibrosis grade 3 occurred in 4 and grade 4 in 6 patients. One patient developed a severe (grade 3) radiation pneu monitis. The low incidence of acute and late side-effects with this tr eatment, combining daily administration of 6 mg cisplatin with radical radiotherapy using a simultaneous boost technique, indicates that esc alation of the radiation dose seems feasible. Copyright (C) 1996 Elsev ier Science Ltd