REPORT OF PHASE-II TRIAL OF CONCURRENT CHEMORADIOTHERAPY WITH RADICALTHORACIC IRRADIATION (60 GY), INFUSIONAL FLUOROURACIL, BOLUS CISPLATIN AND ETOPOSIDE FOR CLINICAL STAGE IIIB AND BULKY IIIA NONSMALL CELL LUNG-CANCER
Cj. Langer et al., REPORT OF PHASE-II TRIAL OF CONCURRENT CHEMORADIOTHERAPY WITH RADICALTHORACIC IRRADIATION (60 GY), INFUSIONAL FLUOROURACIL, BOLUS CISPLATIN AND ETOPOSIDE FOR CLINICAL STAGE IIIB AND BULKY IIIA NONSMALL CELL LUNG-CANCER, International journal of radiation oncology, biology, physics, 26(3), 1993, pp. 469-478
Citations number
25
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To assess the response rate, median and long-term survival of
patients (pts) with locally advanced, initially inoperable non-small
cell lung cancer (NSCLC) treated on a phase II study of radical thorac
ic radiotherapy (TRT) and concurrent radiosensitizing chemotherapy. Me
thods and Materials: From 3/87 to 7/90, 41 previously untreated patien
ts at Fox Chase Cancer Center with locally advanced non-small cell lun
g cancer, 24 with bulky clinical Stage IIIA, and 17 with IIIB disease,
received concurrent thoracic radiotherapy (60 Gy/2.0 Gy/d in 6 weeks)
and 2 cycles of infusional 5FU (640-800 mg/m2/24 hrs X 5 d); cisplati
n (20 mg/m2 qd X 5); and etoposide (50 mg/m2 d 1, 2, 5) administered d
ays 1 and 28 of TRT. Results: Forty of 41 were evaluable. Response rat
e was 90%, with radiographic CR in 20%. Thirteen pts (33%) underwent t
horacotomy and complete resection with clinical downstaging in 10, inc
luding three pathologic CR's. Overall median survival was 14 months an
d 2-year survival was 38% with no difference between CS IIIA and IIIB
pts (p = 0.2224). At median potential follow-up of 42 months, 8/40 pts
. (20%) are alive and progression-free, including 4 of 13 resected pts
. The chief toxicity was esophagitis, occurring in 32 pts. (80%), Grad
e 3-4 in 21 (52%), with 13 (33%) requiring hospitalization and 7 (18%)
needing TPN. Grade 3-4 granulocytopenia was noted in 20 pts. (50%) wi
th ten episodes of fever mandating intravenous antibiotics. Cardiac is
chemia was documented in 2 (5%). Of 13 thoracotomy pts, six underwent
lobectomy without perioperative mortality; 3 of 7 pneumonectomy pts di
ed post-operatively, two from broncopleural fistula, and one from ARDS
. Conclusion: This aggressive regimen produced a 2-year survival (38%)
comparable to the best arm of cancer and leukemia groups B study 8433
, which administered radical thoracic radiotherapy after protoadjuvant
vinblastine and cisplatin in similar and earlier stage non-small cell
lung cancer patients. Toxicity, particularly esophagitis, was severe,
but of short duration. An unacceptably high complication rate was see
n following pneumonectomy, but not lobectomy.