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Cisplatin plus vinorelbine combined with radiation in locally advanced non-small cell lung cancer
Abstracts were 16.6% and 9%; local progression free survival at 2 and 5 years were 28.2% and 28.2% and distant metastasis free survival were 48.9% and 34.8%, respectively. The responders showed significantly better survival than non-responders (p=0.01) but adjuvant chemotherapy did not show any significant benefit in overall and disease free survival. Although we included the more advanced patients, this aggressive regimen produced a high rate of locoregional response and the 2 and 4 year survival were comparable to the most active multimodality regimens reported in locally advanced NSCLC. Cisplatin plus Vinorelbine combined with radiation in locally advanced non-small cell lung cancer P. Zatloukal, L. Petruzÿelka, M. Zemanov‡, F. Krejbich, L. Havel, P. Fiala: Czech Lung Cancer Cooperative Group, Prague, Czech Republic. To assess the feasibility, toxicity and efficacy of concurrent chemo-radiotherapy using cisplatin plus vinorelbine regimen. From July 1996 to June 1997, 20 patients were enrolled: 15 males, 5 females; mean age 61.1 yrs (range 44-73), mean Karnofsky PS 87; histology: squamous 15, large cell 2, adenosquamous 1, adenocarcinoma 1. undifferentiated 1; clinical stage IIIA 4, IIIB 16 pts. Chemotherapy (CT) consists of four cycles of cisplatin 80mg/m2 on day 1 and vinorelbine 25mg/m2 on days 1,8,15. The dose of vinorelbine was reduced to 12.5mg/m2 during cycle 2 and 3. Cycles were repeated every four weeks and the beginning was scheduled on Fridays. Radiotherapy (RT) started from day 4 of cycle 2 (60Gy/30fr/6weeks). RT was given prior to CT on days 8,15 (cycle 2) and 1,8,15 (cycle 3) and was followed by two weekend days rest. Sixteen out of 20 pts were evaluable for response. The overall objective response rate was 62.5%, with 18.7% of complete responses. The treatment was well tolerated. WHO grade 3 or 4 toxicity: anemia 5%, leucopenia 26%, nauzea/vomiting 16%, esophagitis 5% of cycles. Febrile neutropenia occurred in 9% of cycles and was not severe. Median survival was 54.4 wk and 1 -yr survival was 52.6%. Our pilot study has shown that DDP+VRN with simultaneous thoracic RT is feasible combined modality treatment with acceptable toxicity. Low incidence of esophagitis is probably due to the schedule in which RT precedes CT and following two weekend days rest avoids radiation injury of tissue highly saturated by cytostatic agents. High dose rate endobronchial brachytherapy for malignant airway obstructions KH Shin, EK Choi, HS Chang, JH Kim, SD Ahn, YJ Nho, KJ Kim Dept. of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea This study was designed to 1) standardize endobronchial brachytherapy for the patients with malignant airway obstruction, 2) to evaluate the effectiveness in symptom palliation and relief of objective signs, 3) to find the unexpected complications. Starting on May 1991, 105 patients were treated using a high dose rate remote afterloading unit. Group 1 patients (n=40) were treated with curative intent and received 500 cGy at 1 cm depth for three fractions twice a week in combination with 6500 cGy of external RT. Group 2 patients (n=35) had recurrent disease after prior curative external RT. Group 3 patients (n=30) who had M1 disease or poor performance status ineligible for the curative treatment were treated with palliative intent. Group 2 and 3 patients received 700 cGy at 1 cm depth for 3-4 fractions weekly. Ninety-four (89.5%) were
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patients with non-small cell lung cancer, 7 (6.7%) with tracheal malignancies, and 4 (3.8%) with endobronchial metastases. Evaluation consisted of symptom index scoring with weighted responses of obstructive pneumonia 91%, dyspnea 82%, hemoptysis 76%, and cough 71%. Objective improvement by X-ray or bronchoscopy was 77% overall, curative 78%, palliative and recurrent 76%. Complications arising from this procedure was 10%, including 2 pneumothorax, 2 massive hemoptysis, and 6 radiation bronchitis and stenosis. Four patients had grade 3 radiation bronchitis which was characterized by a severe inflammatory response with a marked membranous exudate. These patients required multiple debridement to re-establish the full lumen of the airway and they are all stable now. But 2 patients had grade 4 which was differentiated by the greater degree of fibrosis with resulting circumferential stenosis. They received multiple laser photoresection but died. High dose rate endobronchial brachytherapy is a simple and well tolerated procedure with minimal morbidity. It provides excellent palliation of the endobronchial portion of neoplastic disease improving respiratory symptoms as well as patients general performance status. Based on this study, use of endobronchial brachytherapy in curative setting as a boost technique was warranted. Palliative radiation therapy: a feasible treatment for octogenarians diagnosed as having locally advanced NSCLC Won Chang M.D., Abraham Chachoua M.D., Alan Steinfeld M.D., Department of Radiation Oncology, NYU Medical Center, New York, NY, USA Introduction: The geriatric age group is the fastest growing segment of the US population. The incidence of lung cancer in this group is rising. We report the feasibility and outcome of treatment of octogenarians who received palliative radiation therapy for locally advanced NSCLC. Materials & Methods: From 1981 to 1996, 232 patients having locally advanced or metastatic non-small cell lung cancer (NSCLC) were treated to the primary tumor with palliative radiation therapy. Thirty-three of these patients were octogenarians. The dose of radiation ranged from 3000 cGy in 10 fractions and 4005 cGy in 15 fractions depending on prognostic factors such as KPS and weight loss at presentation. Treatment volume included primary lung tumor, ipsilateral hilum, and adjacent mediastinum. While the goal of treatment was palliation of symptoms due to local disease, survival as used as the endpoint as it was objective and readily verifiable. Results: The mean/median age for Octogenarians and Nonoctogenarians were 84/83 and 65/67 respectively. Karnofsky Scores are similar (mean/median): 70/70 versus 71/75. Less proportion of octogenarian patients had weight loss (> 10% total body weight): 13% versus 21%. Median survival were similar for both groups: 9.5 months versus 8.2 months. 82% of octogenarians and 80% of non- octogenarians completed their intended course of treatment. Conclusion: In NSCLC, advanced age does not preclude the delivery effective palliative radiation therapy. The majority of patients complete planned course of therapy. Survival is comparable to ÔyoungerÕ patients. Phase-II trial of Taxotere (TXT) and Navelbine (N) as first-line therapy in patients (PTS) with advanced non-small cell lung cancer (ANSCLC) M. O'Rourke, D. Garfield, P. Ellis, American Oncology Resources, Houston, TX, USA, and Rhone-Poulenc Rorer Pharmaceuticals Inc., Collegeville, PA, USA. The purpose of this study is to determine the response rate of
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patients with non-small cell lung cancer, 7 (6.7%) with tracheal malignancies, and 4 (3.8%) with endobronchial metastases. Evaluation consisted of symptom index scoring with weighted responses of obstructive pneumonia 91%, dyspnea 82%, hemoptysis 76%, and cough 71%. Objective improvement by X-ray or bronchoscopy was 77% overall, curative 78%, palliative and recurrent 76%. Complications arising from this procedure was 10%, including 2 pneumothorax, 2 massive hemoptysis, and 6 radiation bronchitis and stenosis. Four patients had grade 3 radiation bronchitis which was characterized by a severe inflammatory response with a marked membranous exudate. These patients required multiple debridement to re-establish the full lumen of the airway and they are all stable now. But 2 patients had grade 4 which was differentiated by the greater degree of fibrosis with resulting circumferential stenosis. They received multiple laser photoresection but died. High dose rate endobronchial brachytherapy is a simple and well tolerated procedure with minimal morbidity. It provides excellent palliation of the endobronchial portion of neoplastic disease improving respiratory symptoms as well as patients general performance status. Based on this study, use of endobronchial brachytherapy in curative setting as a boost technique was warranted. Palliative radiation therapy: a feasible treatment for octogenarians diagnosed as having locally advanced NSCLC Won Chang M.D., Abraham Chachoua M.D., Alan Steinfeld M.D., Department of Radiation Oncology, NYU Medical Center, New York, NY, USA Introduction: The geriatric age group is the fastest growing segment of the US population. The incidence of lung cancer in this group is rising. We report the feasibility and outcome of treatment of octogenarians who received palliative radiation therapy for locally advanced NSCLC. Materials & Methods: From 1981 to 1996, 232 patients having locally advanced or metastatic non-small cell lung cancer (NSCLC) were treated to the primary tumor with palliative radiation therapy. Thirty-three of these patients were octogenarians. The dose of radiation ranged from 3000 cGy in 10 fractions and 4005 cGy in 15 fractions depending on prognostic factors such as KPS and weight loss at presentation. Treatment volume included primary lung tumor, ipsilateral hilum, and adjacent mediastinum. While the goal of treatment was palliation of symptoms due to local disease, survival as used as the endpoint as it was objective and readily verifiable. Results: The mean/median age for Octogenarians and Nonoctogenarians were 84/83 and 65/67 respectively. Karnofsky Scores are similar (mean/median): 70/70 versus 71/75. Less proportion of octogenarian patients had weight loss (> 10% total body weight): 13% versus 21%. Median survival were similar for both groups: 9.5 months versus 8.2 months. 82% of octogenarians and 80% of non- octogenarians completed their intended course of treatment. Conclusion: In NSCLC, advanced age does not preclude the delivery effective palliative radiation therapy. The majority of patients complete planned course of therapy. Survival is comparable to ÔyoungerÕ patients. Phase-II trial of Taxotere (TXT) and Navelbine (N) as first-line therapy in patients (PTS) with advanced non-small cell lung cancer (ANSCLC) M. O'Rourke, D. Garfield, P. Ellis, American Oncology Resources, Houston, TX, USA, and Rhone-Poulenc Rorer Pharmaceuticals Inc., Collegeville, PA, USA. The purpose of this study is to determine the response rate of