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KMID : 0982820050040010027
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Journal of Lung Cancer
2005 Volume.4 No. 1 p.27 ~ p.33
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Induction Chemotherapy Followed by Concurrent Chemoradiotherapy in Patients with Unresectable Stage III Non- small Cell Lung Cancer
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Park Hee-Chul
Kim Su-San
Bae Hoon-Sik
Kim Hyo-Jung
Zang Dae-Young
Park Young-Iee
Kim Dong-Gyu
Chung Ki-Suck
Ahn Jin-Seok
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Abstract
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Purpose: We conducted a phase II trial of the addition of a paclitaxel and cisplatin regimen as induction chemotherapy to concurrent thoracic radiation therapy and weekly paclitaxel and cisplatin in locally advanced unresectable stage III non-small cell lung cancer. The endpoints were to determine the applicability, safety, response rate and survival statistics.
Materials and Methods: The induction chemotherapy consisted of paclitaxel 175 mg/m2 given 3 hours on day 1 and cisplatin 75 mg/m2 given over 1 hour on day 2 repeated 3 weeks for two cycles. Thoracic radiation therapy 63 Gy/35 fractions in daily 1.8 Gy fractions along with paclitaxel 45 mg/m2/1 hr and cisplatin 20 mg/m2/1 hr given 2∼4 hours before irradiation repeated every week for 6 cycles. To minimize the toxicities of a concurrent portion of treatment, the treatment planning for thoracic radiation therapy was done throughly with the assistance of a planning CT scans and computerized radiation treatment planning system.
Results: Twenty-nine patients were enrolled between Sep 1999 to Sep 2002. The overall response rate after the induction chemotherapy was 79.3%. Due to the refusal of further treatment, 1 patient left the trial. Twenty-three (79.3%) of the 29 patients received the concurrent portion of treatment. Five (17.2%) patients received the radiation therapy alone, two due to refusal, two for decreased performance stati, one due to pulmonary abscess. After completion of the entire course of treatment, 5 (17.2%) patients gained the complete remission and the overall response rate of 79.3%. With a median follow-up of 22 months, the 1-, 2- and 3-year overall survival rates were 75.7, 53.4 and 41.6%. The progression free survival rates were 52.5 and 20.5% at 1- and 2-year, respectively. Induction chemotherapy was well tolerated. Among 23 patients who completed the entire course of treatment including the concurrent portion, 6 (34.8%) suffered hematologic toxicities more than grade 3, 2 (8.7%) had esophagitis greater than grade 3 and 3 (13.3%) had radiation pneumonitis greater than grade 3.
Conclusion: We concluded that weekly Paclitaxel?Cisplatin with concurrent radiotherapy following 2 cycles of induction chemotherapy with Paclitaxel?Cisplatin repeated 3 weeks is effective and well- tolerated, should be further evaluated in a randomized phase III trial.
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KEYWORD
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Non-small cell lung cancer, Induction chemotherapy, Concurrent chemo-radiotherapy, Paclitaxel, Cisplatin
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