A PILOT TRIAL OF HYPERFRACTIONATED THORACIC RADIATION-THERAPY WITH CONCURRENT CISPLATIN AND ORAL ETOPOSIDE FOR LOCALLY ADVANCED INOPERABLE NON-SMALL-CELL LUNG-CANCER - A 5-YEAR FOLLOW-UP REPORT

Purpose: To improve the outcome of patients with locally advanced inop erable non-small cell lung cancer (NSCLC), we conducted a pilot trial of concurrent chemoradiation therapy using a cisplatin and oral etopos ide regimen given concurrently with hyperfractionated radiation therap y. Methods and Materials: In this single-institution pilot trial, we e nrolled 23 patients with inoperable Stage IIIa (4) and mb (19) NSCLC, Treatment consisted of two cycles of chemotherapy with oral etoposide 50 mg one day alternating with 50 mg b.i.d. (50 mg/day if BSA is < 1.7 0 m(2)) on days 1-21 and intravenous cisplatin (40 mg/m(2)) on days 1 and 8 of a 28-day cycle. Radiation therapy was given twice a day (1.2 Gy per fraction), 5 days a week, to a total dose of 69.6 Gy in 58 frac tions over 6 weeks. Results: Overall, 18 (78%) of the 23 patients comp leted the chemotherapy as planned and 21 (91%) received thoracic irrad iation per protocol. One patient died of radiation pneumonitis. Fourte en (78%) of 18 evaluable patients achieved objective responses. The me dian survival duration was 9.3 months for all patients and 20.2 months for 15 patients who had no more than 5% weight loss. After a minimum follow-up of 5 years, five patients (1 IIIa, 4 IIIb) are still alive a nd disease-free, which gives an actual 5-year survival rate of 22%, Fo ur of the five 5-year survivors were among those who completed the tre atment as planned. Conclusion: This long-term survival outcome compare s favorably with that of other chemoradiation therapy trials and even with those reported in multimodality trials including surgery. These r esults suggest that intensive concurrent chemoradiation therapy is fea sible, and some patients,vith locally advanced inoperable NSCLC may en joy long-term survivorship following nonsurgical therapy. (C) 1998 Els evier Science Inc.