Treatment of locally-advanced NSCLC by concomitant chemotherapy (CTx), HDR brachytherapy (BTx) and conformal external beam radiation therapy (XRTx)

Abstract

18504 Background: Efforts to achieve local control and improve survival in patients (pts) with locally-advanced, non-resectable NSCLC continue to evolve. XRTx as the sole treatment modality has been replaced by concomitant CTx + XRTx based on improved survival with acceptable tolerance. Further attempts to improve clinical outcomes have investigated XRTx dose intensification through hyper- fractionation. An alternative to this strategy offering certain practical advantages to hyper-fraction treatment is the use of BTx in conjunction with XRTx. This exploratory retrospective study assessed the efficacy of BTx in conjunction with conformal XRTx plus CTx in pts with surgically-unresectable, locally advanced NSCLC. Methods: Clinical results for newly-diagnosed, NSCLC patients (n=21) with either Stage IIIA (T1 or T2, N2, MO or T3, N1 or N2, MO) or Stage IIIB (Tx, N3, MO or T4, Nx, M0) tumors were abstracted from the medical records of pts treated at the Southwestern Regional Medical Center of Cancer Treatment Centers of America. There were 9 IIIA and 12 IIIB tumors with squamous histology (n=9); adenocarcinoma (n=3); large cell tumors (n=3); and mixed cell types (n=6) being seen. All pts received combination, platinum-based CTx in conjunction with XRTx (60 Gy) + 4–6 cycles of BTx (500 cGy/treatment). Results: Median survival for the population was 18.22 months. Median survival for Stage IIIA was 18.6 months and for Stage IIIB was 16.4 months. Resolution of treated endobronchial lesions and/or substantial necrotic tissue without endoscopic evidence of significant residual viable tumor was observed on repeat bronchoscopic examination in the treated tumor mass for most patients. Planned multimodality therapy was completed on all patients with tolerable and expected toxicity. Conclusions: The results demonstrate that therapy for locally advanced, NSCLC which includes BTx is clinically effective and well tolerated. The comparatively low incidence and severity of radiation-associated toxicities suggests further development of this approach for treatment of Stage IIIA and IIIB NSCLC is warranted. No significant financial relationships to disclose.