CHEMORADIATION IN ADVANCED NONSMALL CELL LUNG-CANCER

Purpose: Resectability, local control, and survival were evaluated in advanced stage nonsmall cell lung cancer treated with simultaneous che moradiation therapy delivered in an accelerated, interrupted twice-a-d ay schedule. Methods and Materials: Forty-seven consecutive patients w ith Stage IIIA or IIIB nonsmall cell lung cancer, consenting to partic ipation in the study, received cisplatin, 30 mg/m(2) for 3 days, etopo sid, 80 mg/m(2) for 3 days, and 5-fluorouracil, 900 mg/m(2) for 4 days . Radiation therapy consisted of 2 Gy given twice a day for 5 days. Tw o weeks rest was planned between cycles. Patients were evaluated for r esectability after the second cycle. Any patient with unresectable tum or received a third cycle of treatment. Results: Forty-seven patients were evaluable for acute toxicity: eighteen (38%) required an extended rest period for esophagitis or low blood count; 3 (6%) had sepsis, of whom 1 (2%) expired. Three patients (6%) had multiple blood transfusi ons for low hemoglobin. Median follow-up is 23.6 months, with a range of 10-49 months. Nine patients (19%) failed locally; 15 (32%) had loca l and distant failure; 7 (15%) failed only at distant sites. Twelve pa tients (25.5%) are alive with no evidence of disease; 4 patients were lost to followup with disease. The 2-year actuarial survival is 49%, a nd the 4-year is 28.2%. Conclusion: Simultaneous chemoradiation is wel l tolerated with acceptable toxicity. The overall 2- and 4-year actuar ial survival is somewhat better than that reported in the literature. Resectability in Stage IIIB patients was not increased with this regim en nor was any surgical specimen free of cancer. The 47% distant failu re rate is not different from those reported by others.