Report of phase ii trial of concurrent chemoradiotherapy with radical thoracic irradiation (60 gy), infusional fluorouracil, bolus cisplatin and etoposide for clinical stage IIIB and bulky iiia non-small cell lung cancer

Corey J. Langer, Walter J. Curran, Steven M. Keller, Robert Catalano, Wyatt Fowler, Kenneth Blankstein, Samuel Litwin, Partha Bagchi, Sherrie Nash, Robert Comis

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Abstract

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 thoracic radiotherapy (TRT) and concurrent radiosensitizing chemotherapy. Methods and Materials: From 3/87 to 7/90, 41 previously untreated patients at Fox Chase Cancer Center with locally advanced non-small cell lung 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 × 5 d); cisplatin (20 mg/m2 qd × 5); and etoposide (50 mg/m2 d 1, 2, 5) administered days 1 and 28 of TRT. Results: Forty of 41 were evaluable. Response rate was 90%, with radiographic CR in 20%. Thirteen pts (33%) underwent thoracotomy and complete resection with clinical downstaging in 10, including three pathologic CR's. Overall median survival was 14 months and 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%), Grade 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%) with ten episodes of fever mandating intravenous antibiotics. Cardiac ischemia was documented in 2 (5%). Of 13 thoracotomy pts, six underwent lobectomy without perioperative mortality; 3 of 7 pneumonectomy pts died 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 seen following pneumonectomy, but not lobectomy.

Original languageEnglish (US)
Pages (from-to)469-478
Number of pages10
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume26
Issue number3
DOIs
Publication statusPublished - Jun 15 1993

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Keywords

  • Combined modality therapy
  • Concurrent chemoradiotherapy
  • Locally advanced non-small cell lung cancer
  • Radical thoracic radiation
  • Stage III NSCLC

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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