carboplatin for stage III non-small cell lung cancer

SI51 590

591

Treatment r e s u l t s in 6 5 p a t i e n t s w i t h b r a i n m e t a s t a s i s f r o m lung adenocarcinoma after radiosttrgevy alone (Gamma Knife) ) r c o m b i n a t i o n t r e a t m e n t with a d d i t i o n a l f r a c t i o n a t e d external beam t h e r a p y * i i o ,t' ~,l';~h,I ..... ' ' ,

RADIOTHERAPY VERSUS RADIOTHERAPY ENHANCED BY CISPLATIN IN INOPERABLE N O N M E T A S T A T I C N O N S M A L L CELL LUNG CANCER (NSCLC): P R E L I M I N A R Y RESULTS OF A R A N D O M I Z E D STUDY

Dieckmann. K , *Kitz, K .*Sch0ggl, A ;*Ertle, A . POtter. R Department o f Radiotherapy and Radiobiolog~. * Department o f Neurosurgery. University o f Vienna, Austria .,.. , , , ,

SABAN (~AKIR. IDRIS YUCEL. [BRAHJM EGEHAN. BULENT K0~OKPLAK~I. BABUR SOYLU. YE$iM ELGIN. NILGON 0ZBEK Department of Radia[ion Oncolog)'. Ondokuz Ma)'ls Unis'crsiP,. Medical School. 55139. Kurupolit. Samsun. Turkey

Material and methnds t,5 pls (48 male. mediau age 54 ',carsl ~,~llh hmg adenocarcmoma (LAC} suffering from umhlplc or solaal3 branl metastases (BMI ',tere treated uilh radiosnrgcu, (RS) alone 129 pls) m one fiaction or RS combined '.'.lth fraclionated e'..ternal beam radlotherap?' (EBRI) (36 pts) from 9/92 Io 11)/95 Pts '.'.lib RS alone recel'.ed Ib-2tl G) prc'scrlbed on the 5()'%-lsodose pts t~lth combination trcalnlenl rccet,.ed addlhonal EBRT "¢~llh ~1) G3 m IO fractions '.'.llhin I',',o ~.~.eeks to Ihe '~tholc brain O~.erall IrealmeUl tnnc v. as 4 ',',t2cks Including RS performed before or after EBRT 51/65 pls (7g~b) had mulllple BM 12-111 sites), based on ,",.1RI-mfornlalton Tumor '~ohlnle rnnged front [I 1~ Io 42 cent Ileadacbe. dl//iness, dlffcrenl forms of paral?'sls, focal and gencrah/cd scl/urcs '¢,erc Ihc prcdonllllant neurological s?,mptoms Results: Nenrologlcal s~lnptonls dlsseappcared :~lftllll I IO 2 ~ceks aflcr radiosHrgery ill about 51)*/~, After RS. rednction of tumor '¢olumc '.~,a54{P%lo 71)0.. e~,ahlaled on CT/MRI after three "~,.eeks Remission Sleadil} progressed '~ith lucrcasc in follo,.,,-up Tile CNS relapse free time ',',as longer aficr RS aud EBRT than after RS alone: g CNS relapses v,cre obser'.cd aflcr RS alone during Ibe first fi,.c months. "~ after RS and EBRT during the same period, addamual ~ after longer follo'¢.-up CNS relapses m Ih¢ area of RS ",'~credetected m 2 pls. ~.~ho recel,,cd less Ihan Ihe prescribed dosc of 16-2n G3 After RS alone sur~ P,al r;nlged from l) 4 IO 12.6 nahs. after RS~EBRT from 0.5 to 22.¢, mlhs. median Stl~ i,.al did not die-or slgnd~cand~. 55/(,5 plS 185".} died front non cerebral lunlor progression Cnnclusion In BM front I.AC. RS alone or RS+[-I:IRF mdnce significant tumor rentisston and lead to rapid Intpro'~enlcnt o1 ncllrOlOglC,'lls3nlploms Addltlomd EBRT does not prolmlg mcdmn sun t,.al slgmficantl 3. but seems to dcla.', the occurcucc of CNS relapses in areas uol treated b) RS

Background: Cisplatin has been reported to enhance the cell-killing effect of radiation, an effect ".,,hose intensity ','aries v,ith the schedule of administration Purpose: To conrpare fraclionated radiotherapy tRT) alone I64 Gy/32 fractions/6.5 ',,.eeks) versus same RT plus clsplatin (20 mg/m" iv. days 1-5 of second and sixth Ircatmenl '.'.eek before RT) Material and methods: Patients ~cre included in the trial if the)' had inoporablc NSCLC in stage I. II or Ill that had been confirmed histologically: had no e',idence of distant metastases on clinical or biochenucal examination: ",,,ere no than 70 ?,'cars old: had medical contraindicalions to operanon tstage I. IlL had a performance status of 2 or less according to the scales of the ECOG. and had a creatinine <1.5 mg/lO0 ml We randondy assigned 53 pat~enls to one of I,ao trentmenls: RT for 6-7 ~.~ks (2 G~, ~P.en 32 limes in fi',c fractions a ',',eek) or RT in the same schedule, combined v,uh 2() nlg/nl2 cisplatin, gl'.en on davs I-5 of the second and Slxlh Ircatmenl x',eek Results: An o',erall response rate of 48% ','.as obscned in RT aloue group and 6 4 " in the cootbdred treatment group, resp¢clivel) No differences in Ihe pauern of relapse ',,.ere noted ber,~.ccn the I',',o treatment groups. Median lime to progressmn ','.as 8 months for RT alone group and I0 months for the other group. One-year sunival rates v,ere 45°/, and 60%. respocti,,'ely. Toxicil) '.'.as acceptable and no treatment-related death occurred in either Ircatnlcnl schedule Conclusion: In this slnd} no significant advanlage of the combined treatment o'.cr RT alone v.as found Ke', v.ords Non-slnall cell lung cancer, cisplatm, radiolhcrap}. radioscnslllZcr

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E V A L U A T I O N OF S E R U M L E V E L S O F C Y F R A 21-1 D U R I N G R A D I O T H E R A P Y T R E A T M E N T IN S Q U A M O U S C E L L L U N G CARCINOMA

CONCURRENT PACLITAXEL. CARBOPLATIN AND RADIATION THERAPY FOLLOWED BY ADJUVANT PACLITAXEL/CARBOPLATIN FOR STAGE 111 NON-SMALL CELL LUNG CANCER

Jacobs I., G o o r C., Van den Weyngaert D.. Radiotherapy dept. A.Z. Middelheim, Antwerp, Belgium

H Ch~L'., W Akerley, H Safran. S. Graztano. C. Chung. B Cole Vanderbdl LImversay. TN, Clinical OncoIngy Group or Rh~vdeIsland. RI. SUN'( Health Sciences Center. Syracuse. NY. USA.

From Jan '95 till Feb '96 a prospective study was conducted to e v a l u a t e C y f r a 21-1 serum levels, a new tumor marker for lung c a r c i n o m a based on a cytokeratin 19 fragment, during and after r a d i o t h e r a p y treatment for s q u a m o u s cell lung carcinoma. The objective o f the study was to investigate a possible prognostic value for treatment efficacy. Material and method : A total o f 14 patients (6 stage I, 6 stage I l i a and 2 stage IIIB), with h i s t o l o g y proven s q u a m o u s cell lung c a r c i n o m a , n o n - m e t a s t a t i c d i s e a s e and w i t h o u t any p r e v i o u s treatment were send to our department for curative radiotherapy. T w e l v e out o f fourteen patients (86%) had positive Cyfra 21-1 serum levels (>1.8 ng/ml) at d i a g n o s i s time. T w o patients with initial normal Cyfra levels were excluded from further investigation. Serum s a m p l e s were taken at diagnosis time. weekly during radiation and two months after treatment. Results : The in- or decrease o f the Cyfra levels with reference to the initial value, were examined. Four out o f twelve patients had a significant increase of the Cyfra 21-1 serum level during the first two weeks o f treatment. They all had progressive disease and died rapidly after treatment (mean S 2.5 months). The other patients showed further decreasing values at the end o f treatmenl. In this group two died five m o n t h s after treatment. They both showed s i g n i f i c a n t increase o f Cyfra levels two months after radiotherapy. The other six patients are still alive with a mean follow-up o f seven months. C o n c l u s i o n : Cyfra 21-1 might be a useful new tumor marker in s q u a m o u s cell lung carcinoma. Analysis of the serum Cyfra levels d u r i n g radiotherapy reveals it's possible use as an indicator for treatment efficacy : if Cyfra serum levels are increasing during the first two weeks o f radiotherapy, treatment modality could possibly bc changed to a palliative schedule instead of curative. Further i n v e s t i g a t i o n and a larger patient population however, is elementary to con firnl this tendency.

Pachtaxel i~ a no~cl anlimicrotuhule agent thai potentiates Ihe effect~ qll ionizing radiation

in v i l r o , itl v i v o

and has acllvi[y againsl non-

small cell lung cancer (NSCLCt, B~tsedon our previous experience in phase I and II studies

of pacldaxel/RT in stage Ill NSCLC. '..,.,=

perlilrmed another phase II at pacqitaxel 50mg/m2/wk]y as a I hour mfusmn and carboplatin AUC of 2/wkly filr 7 weeks wdh radiation Io the pnmar) tumor and regional lymph n~Jes 144 Gyl Iollowed by a h~.~st to the tumor 122 Gy).

In addition m c~mcurrcnl cbemo-RT.

pahenis recewe additional 2 cycle of laxol(2t)O mg/m21 and carb~phaln(AUC 61 every 3 weeks. From March 1995 o.t Fehmar7 1996, 23 patients have been entered in Ibis study. The overall rcsp~mse rate Iconlplete plus partial responses) was 82c,~

The major h~xicily

was es,,)phagms. 45c~ of patients( 9 pt. I had grade 3 ~)r 4 esophagilis at the end ol ctmcurrent phase. 7 oul of 9 panents recover cs..~phagilts ,.',ithin 2 weeks and received planned additional 2 cycles of standard d~e ~,f paclaaxel and carboplalm

Only one patient (4c,i) luld ~.wade 4

pneunt~lnlliS, again recovered within 2 weeks and received [m)slermr Chemo

Combined modahty therapy with pachtaxel, earboplatin and

radlallun is a pr,,)nlislng treatment Iklr k~cally advanced NSCLC with a lush r,.'sponr,e rate and acceptable [OXlCdy