Chemoradiation enhances response in stage IIIB lung cancer

Abstract

Upon workup, the vast majority of non-small cell lung cancer patients are unresectable. Classically these patients undergo external beam radiation alone to 6,000 cGy which results in a disappointing 8.9 month median survival and high local failure rate. To enhance response, radiation dose was escalated and combined with multiagent chemotherapy for patients with stage IIIB non-small cell lung carcinoma. Eight patients (ages 54–75 years, mean 63 years) were initiated on CT guided radiation therapy to the primary tumor, mediastinum, and ipsilateral supraclavicular fossa to 5,400 cGy in 200 cGy/day fractions. The primary tumor bed was then boosted to 7,400 cGy at 200 cGy/day. Concomitant with the radiation boost 4–6 monthly cycles of Cisplatinum and VP16 were initiated in an outpatient setting. Diflucan and Carafate were dispensed to minimize mucositis during radiation therapy. All eight patients completed the prescribed treatment course without interruption. No patient was hospitalized due to treatment-related toxicity and mucositis was minimal. At 12 month follow-up each patient was alive without pulmonary complaint and radiographically none had disease progression at the primary site. Four patients developed evidence of metastatic disease: one at 4 months (brain), the second at 9 months (brain), the third at 12 months (bone), and the fourth at 18 months (contralateral lung). Overall, median survival was 24 months (range 15–40 months). In conclusion, dose escalation of radiation with concomitant chemotherapy offers excellent pulmonary palliation without undue morbidity. Local control and survival appear to be increased compared to radiation alone but further evaluation is required in larger trials. Radiat Oncol Invest 1996;4:171–175. © 1996 Wiley-Liss, Inc.