Abstract
BackgroundCombined chemoradiotherapy (CRT) is the treatment of choice for stage III NSCLC. Gemcitabine (G) is a novel deoxycitidine analogue that has been proven to be a potent radiosensitizer. Twenty-two consecutive patients were treated with concurrent CRT to demonstrate the tolerability and efficacy of low dose G given weekly as radiosensitizer in stage III NSCLC.MethodsPatients with KPS ≥70, adequate bone marrow reserve, with no prior radiotherapy (RT) and surgery were included. Eighteen patients had received prior induction chemotherapy (CT). G (75 mg/m2/week) was infused over 1 hour for 6 weeks. Thoracic RT was given two hours later over 6 weeks at 1.8 Gy/day fractions (total dose of 61.2 Gy). Pulmonary toxicity was evaluated with computed tomography scans in 6 weeks.ResultsMedian age was 60 years (range, 48–75), median follow-up was 15 months (range, 2–40). Sixty-eight percent of patients were male and median KPS score was 90. Conformal 3D-RT planning was used in 64% of patients. G was given for a median of 5 weeks (range 1–9). Twelve patients (54.6%) received all planned CT. G was stopped because of intolerance in 6 and death in 2 patients. Seven patients (31.8%) had radiation pneumonitis. Twenty patients were evaluated for overall response, 1 patient (4.5%) had clinical CR, 81.8% had PR while 9.5% had SD. Median overall survival (OS) was 14 ± 5 months (95% CI 3–25). One- and 2-year OS rates were 55% and 38%. Sixteen patients died of disease-related events (6 with progression of primary tumor, 8 due to metastatic disease), 2 patients died of other causes. One- and 2-year progression-free survival and local control rates were 56%, 27% and 79%, 51%, respectively.ConclusionG might be used as radiosensitizer for patients with stage III NSCLC who could not receive full doses CT with concurrent RT.
Highlights
Combined chemoradiotherapy (CRT) is the treatment of choice for stage III non-small cell lung cancer (NSCLC)
Consecutive patients between the ages 18–75 years with histological or cytological confirmed stage III NSCLC who had Karnofsky Performance Status (KPS) ≥70 in Medical and Radiation Oncology Clinics of Marmara University between December 1999 and July 2002 were considered for this study
Total of 22 consecutive patients were treated with this treatment protocol
Summary
Combined chemoradiotherapy (CRT) is the treatment of choice for stage III NSCLC. Twenty-two consecutive patients were treated with concurrent CRT to demonstrate the tolerability and efficacy of low dose G given weekly as radiosensitizer in stage III NSCLC. 1-year survival rate of patients with local disease is more than 70%, this rate is about 40% for patients with stage III disease [1]. Chemoradiotherapy (CRT) is considered the gold standard treatment of these patients after significant survival advantage and increase in local control had been shown by 3 meta-analyses [2,3,4]. Despite advances in treatment modalities overall 5year survival rate for locally advanced NSCLC remains less than 15% [8]. The spinal cord was not allowed to receive RT more than 45 Gy
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