Results of a phase II concurrent chemoradiotherapy study using three-dimensional conformal radiotherapy with cisplatin and oral etoposide in stage III nonsmall-cell lung cancer

This phase II study was designed to utilize conformal radiation therapy wit h cisplatin and oral etoposide in patients with stage III or locally recurr ent nonsmall-cell lung cancer to determine tolerance and toxicity of therap y. From April 1992-February 1996, 18 patients with pathologically confirmed stage IIIA, IIIB, or locally recurrent nonsmall-cell lung cancer (NSCLC) w ere entered on study. Metastatic workup included a CT scan of the thorax an d upper abdomen as well as a bone scan. Chemotherapy consisted of IV cispla tin (100 mg/m(2)) with IV etoposide (25 mg/m(2)) on day 1; oral etoposide w as given (50 mg/m(2)) days 2-14. Using three-dimensional planning, 40-45 Gy were delivered to the clinical target volume, followed by a boost to the g ross tumor volume for a total of 70 Gy. Patients with recurrent disease rec eived 40-50 Gy in total. Eighteen patients were enrolled: 16 patients were treated with curative intent and were evaluable for outcome. Two patients w ere treated for locally recurrent NSCLC and were not included in the outcom e analysis. Stages included IIIA (44%) and stage IIIB (54%). Forty-four per cent had T3/4 tumors, and 69% had N2/3 disease. Overall survival at I year was 64%, while 2-year overall survival was 50%. Distant metastasis-free sur vival at 1 year was 67%, and at 2 years 60%. The 1-year chest progression-f ree survival was 57%, and at 2 years 50%. Sixty-three percent required hosp italization for dehydration or neutropenia. Fifty-six percent developed leu kopenia (<1,000 cells/mu l) sometime during the therapy. We conclude that c oncurrent cisplatin and oral etoposide with conformal radiation therapy pro vide encouraging results in stage III lung cancer. The major toxicities of this therapy included leukopenia, thrombocytopenia, and mucosal esophagitis . Local progression of disease continues to be a problem with the current d oses given. Future studies should evaluate dose escalation of radiation the rapy with limited volumes, utilizing conformal radiation and chemotherapy t o improve local control and potentially impact upon distant metastases. (C) 1999 Wiley-Liss, Inc.