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2200 Induction thoracic radiotherapy with weekly paclitaxel and carboplatin in marginally resectable locally advanced non-small cell lung cancer (NSCLC)
Proceedings
of the 41 st Annual
arrangements do not rank highly for the endpoints considered, except ranked overall highest (averaged among different sites) in the categories cases.
ASTRO
381
Meeting
arrangement for V,, and MLD. Six field noncoplanar of V,,, V,,, and V,,, for the idealized casles and patient
Discussion: This analysis shows that the “optimal” beam arrangement is dependent on the dosimetric end point used to judge the plans. Ap-pa arrangements, commonly used clinically, do not rank highly for most of the endpoints considered. Arcarrangements are well suited to idealized spherical lesions, but not irregular lesion shapes in actual patients. Contrary to common clinical practice, noncoplanar beam arrangements (especially 6 field noncoplanar arrangements) rank highly within all endpoint categories.
2200
INDUCTION THORACIC RADIOTHERAPY IN MARGINALLY RESECTABLE LOCALLY (NSCLC)
Galloway
ME,
Allegheny
General
Georgiadis Hospital,
M, Landreneau Pittsburgh,
R, Levitt
WITH WEEKLY PACLITAXEL ADVANCED NON-SMALL
M, Colonias
A, Karlovits
S, Kalnicki
CELL
S, Brown
AND CARBOPLATIN LUNG CANCER D
PA, USA
Purpose: Previous reports have suggested that induction chemoradiation has shown encouraging results for treatment of stage III NSCLC. We retrospectively analyzed our single institution experience with induction chemoradiation using weekly paclitaxel (tax) and carboplatin (carb) chemotherapy and correlated assessment of the radiographic to pathologic response to treatment. Methods: From January 1, 1996, to August 15, 1998, 61 patients (pts) with stage IIIA (36 pts) and IIIB (25 pts) NSCLC were initially treated with tax (45 mg/m’/wk) plus carb (100 mglm*/wk) and concurrent conformal thoracic radiotherapy (1.8 Gy fractions, to a total of 45-50 Gy). Patients with radiographic improvement in their disease underwent surgical resection. Those without improvement resumed chemoradiation to a total radiation dose of 60 Gy. Results: Fifty-five patients were assessable for radiographic response. The overall response rate was 5 1 lo; by stage, 50% (17/34) for stage IIIA and 52% (1 l/21) for stage IIIB. There were 5/55 (9%, 4 stage IIIA and 1 stage IIIB) patients that achieved a complete response (CR), 23155 (42%) achieved a partial response, 24/55 (44%) had stable disease, and 3/55 (6%) had disease progression. A CR was observed at the primary site in 6/55 (10%) patients and in the mediastinum in 12138 (32%) patients. Only 3 patients experienced disease progression: one at the primary site and two in the mediastinum. The overall resectability rate was 30161 (49%) pts of which 21136 (58%) pts were stage IIIA and 9/25 (36%) were stage IIIB. Eight pts had a pathologic complete response and an additional 8 pts were downstaged to no nodal disease (NO. With a median follow-up time of 21 months, the projected overall l-year and 2.year survival rates are 64% and 53% respectively. For the 30 pts who went to surgery, the median survival has not yet been reached, and the projected 2.year survival rate is 63%; in contrast; pts who remained unresectable experienced a 13 month median survival and projected 2-year survival of 40% (p=O.O5). The median survival for the 16 pts rendered pathologic TxNO has not yet been reached, and their projected 2-year survival rate is 80%; in contrast, pts who remained node positive experienced a median sui-viva1 of 19 months and projected 2-year survival rate of 48% (p=O.2). A total of 30 patients have died including 7 patients who died of non-cancer-related causes. The intrathoracic failure rate was 7/61 (11%) including 6/61 (10%) without and 1161 (2%) with distant metastases. Distant metastasis alone was the first site of failure in 15/61 (25%) of patients. Brain metastases was noted to be the initial site of failure in S/61 (13%) of patients. The CNS failure rate was 2/S (25%) in patients with squamous cell carcinoma and 6/8(75%)of those with adenocarcinoma or large cell carcinoma. Conclusions: Concurrent weekly paclitaxebcarboplatin chemotherapy and conformal radiotherapy is feasible with encouraging resectability and pathologic CR rates. The impact of resectability on survival is statistically significant, The radiographic response to chemoradiotherapy correlated well with the pathologic stage. The intrathoracic failure rate is low and the metastatic failure rate is consistent with previously reported data in this group of patients. Further prospective evaluation of this regimen and the prognostic influence of lymph node sterilization will be investigated.
of the 41 st Annual
arrangements do not rank highly for the endpoints considered, except ranked overall highest (averaged among different sites) in the categories cases.
ASTRO
381
Meeting
arrangement for V,, and MLD. Six field noncoplanar of V,,, V,,, and V,,, for the idealized casles and patient
Discussion: This analysis shows that the “optimal” beam arrangement is dependent on the dosimetric end point used to judge the plans. Ap-pa arrangements, commonly used clinically, do not rank highly for most of the endpoints considered. Arcarrangements are well suited to idealized spherical lesions, but not irregular lesion shapes in actual patients. Contrary to common clinical practice, noncoplanar beam arrangements (especially 6 field noncoplanar arrangements) rank highly within all endpoint categories.
2200
INDUCTION THORACIC RADIOTHERAPY IN MARGINALLY RESECTABLE LOCALLY (NSCLC)
Galloway
ME,
Allegheny
General
Georgiadis Hospital,
M, Landreneau Pittsburgh,
R, Levitt
WITH WEEKLY PACLITAXEL ADVANCED NON-SMALL
M, Colonias
A, Karlovits
S, Kalnicki
CELL
S, Brown
AND CARBOPLATIN LUNG CANCER D
PA, USA
Purpose: Previous reports have suggested that induction chemoradiation has shown encouraging results for treatment of stage III NSCLC. We retrospectively analyzed our single institution experience with induction chemoradiation using weekly paclitaxel (tax) and carboplatin (carb) chemotherapy and correlated assessment of the radiographic to pathologic response to treatment. Methods: From January 1, 1996, to August 15, 1998, 61 patients (pts) with stage IIIA (36 pts) and IIIB (25 pts) NSCLC were initially treated with tax (45 mg/m’/wk) plus carb (100 mglm*/wk) and concurrent conformal thoracic radiotherapy (1.8 Gy fractions, to a total of 45-50 Gy). Patients with radiographic improvement in their disease underwent surgical resection. Those without improvement resumed chemoradiation to a total radiation dose of 60 Gy. Results: Fifty-five patients were assessable for radiographic response. The overall response rate was 5 1 lo; by stage, 50% (17/34) for stage IIIA and 52% (1 l/21) for stage IIIB. There were 5/55 (9%, 4 stage IIIA and 1 stage IIIB) patients that achieved a complete response (CR), 23155 (42%) achieved a partial response, 24/55 (44%) had stable disease, and 3/55 (6%) had disease progression. A CR was observed at the primary site in 6/55 (10%) patients and in the mediastinum in 12138 (32%) patients. Only 3 patients experienced disease progression: one at the primary site and two in the mediastinum. The overall resectability rate was 30161 (49%) pts of which 21136 (58%) pts were stage IIIA and 9/25 (36%) were stage IIIB. Eight pts had a pathologic complete response and an additional 8 pts were downstaged to no nodal disease (NO. With a median follow-up time of 21 months, the projected overall l-year and 2.year survival rates are 64% and 53% respectively. For the 30 pts who went to surgery, the median survival has not yet been reached, and the projected 2.year survival rate is 63%; in contrast; pts who remained unresectable experienced a 13 month median survival and projected 2-year survival of 40% (p=O.O5). The median survival for the 16 pts rendered pathologic TxNO has not yet been reached, and their projected 2-year survival rate is 80%; in contrast, pts who remained node positive experienced a median sui-viva1 of 19 months and projected 2-year survival rate of 48% (p=O.2). A total of 30 patients have died including 7 patients who died of non-cancer-related causes. The intrathoracic failure rate was 7/61 (11%) including 6/61 (10%) without and 1161 (2%) with distant metastases. Distant metastasis alone was the first site of failure in 15/61 (25%) of patients. Brain metastases was noted to be the initial site of failure in S/61 (13%) of patients. The CNS failure rate was 2/S (25%) in patients with squamous cell carcinoma and 6/8(75%)of those with adenocarcinoma or large cell carcinoma. Conclusions: Concurrent weekly paclitaxebcarboplatin chemotherapy and conformal radiotherapy is feasible with encouraging resectability and pathologic CR rates. The impact of resectability on survival is statistically significant, The radiographic response to chemoradiotherapy correlated well with the pathologic stage. The intrathoracic failure rate is low and the metastatic failure rate is consistent with previously reported data in this group of patients. Further prospective evaluation of this regimen and the prognostic influence of lymph node sterilization will be investigated.