Induction platinum-based chemotherapy followed by radical hyperfractionated radiotherapy with concurrent chemotherapy in the treatment of locally advanced non-small-cell carcinoma of the lung

This study evaluated tolerance, local control, and short-term survival in p atients with locally advanced non-small-cell lung carcinoma treated with in duction chemotherapy followed by radical hyperfractionated radiotherapy wit h concurrent chemotherapy. Thirty-one patients with stage ma (N2) or mb tum ors were treated with cia-platinum-based induction chemotherapy for 1 to 4 courses followed by radical hyperfractionated radiotherapy (69.6 Gy) with c oncurrent chemotherapy given at the beginning and end of radiotherapy. Indu ction chemotherapy produced no complete responses and Is (58%) partial resp onses. After completion of radiotherapy, 4 patients had complete response ( 13%) and 23 patients (74%) partial response. The patterns of failure were a s follows: intrathoracic, 6 patients (22%); intrathoracic + distant metasta sis, 6 patients (22%); distant metastasis without thoracic failure, 5 patie nts (19%). Six patients of the 12 with intrathoracic failure experienced in -field radiotherapy pure local failure. At the time of this analysis, 10 pa tients were alive and well (4 complete and 6 partial responders). Actuarial survival projected at 39 months is 35%. No benefit was observed for those patients responding to induction chemotherapy. Toxicity was as follows: gra de III neutropenic fever in 4 patients (13%), grade IV neutropenia in 13 pa tients (42%), pneumonia in 6 patients (19%), grade III esophagitis in 4 pat ients (13%) and severe clinical pneumonitis in 1 patient (3%). Induction ch emotherapy followed by chemoradiotherapy is feasible, and the preliminary r esults are encouraging. Complete response after radiotherapy appeared to be related to short-term disease-free survival, and decisions based on the re sponse to chemotherapy may be equivocal.