Hyperfractionated radiotherapy following induction chemotherapy for stage III non-small cell lung cancer— randomized for maintenance chemotherapy vs. observation

Radiation Oncology, Biology, Physics Volume 30, Supplement 1

270

1064 HYPERFRACTIONATED CELL LUNG CANCER

RADIOTHERAPY FOLLOWING INDUCTION CHEMOTHERAPY FOR STAGE III NON-SMALL - RANDOMIZED FOR MAINTENANCE CHEMOTHERAPY VS. OBSERVATION -

Eun Kyung Choi, M.D., Hyesook Chang, M.D., Seung Do Ahn, M.D., Kwang MO Yang, M.D., Cheolwon Suh, M.D.*, Kyoo Hyung Lee, M.D.*, Jung Shin Lee, M.D.*, Sang Hee Kim, M.D.*, Youn Suk Ko, M.D.*, Woo Sung Kim, M.D.*, Won Dong Kim, M.D.*, Koun Sik Song, M.D.**, Kwang Hyun Sohn, M.D.#, Department of Therapeutic Radiology, Internal Medicine*, Diagnostic radiology**, Center, College of Medicine, University of Ulsan, Seoul, Korea

Cardiovascular

surgery#, Asan Medical

Purpose : A prospective randomized study for Stage III unresectable non small cell lung cancer (NSCLC) has been conducted to evaluate the response rate and tolerance of induction chemotherapy with MVP followed by hyperfractionated radiotherapy and evaluate the efficacy of maintenance chemotherapy. Materials and Methods : All patients with Stage IIIa or IIlb unresectable NSCLC were treated with hyperfractionated radiotherapy (12OcGy / fx BID, 6480cGy / 54fx) after 3 cycles of induction chemotherapy, MVP (Mitomycin C 6mg/ m2, Vinblastin 6mg/m2f Cisplatin 60mg / m2) and then the responders from induction chemotherapy were randomized to 3 cycles of maintenance MVP chemotherapy or observation. Sixty nine patients were registered to this study until June 1993 ; Among 69 patients 6 refused further treatment during induction chemotherapy and 6 received incomplete radiation therapy because of patient’s refusal. 57 completed planned therapy. Fourteen patients had stage IIIa and forty three had IIIb including the 7 patients with supraclavicular lymph node metastasis and 8 with pleural effusion. Results : After induction chemotherapy thirty three patients ,(58%) had responses, including 3 (5%) with complete and 30 (53%) with partial responses. Among the 33 patients who achieved more than partial response after induction chemotherapy, 19 (58%) showed further regression of tumor after radiothera y. Of the twenty four patients judged to have stable disease or progression after induction chemotherapy, 9 (38%) showed more tRan partial response after radiotherapy. Of the 57 patients who corn leted induction chemotherapy and radiotherapy, 37 atients (65%) including 5 complete responders showed more than partial response. T 1.arty patients were randomized after radiotherapy. T1.lrteen patients were allocated to maintenance chemotherapy moup and 5/13 showedfurtherregression of tumor after maintena& chemotheiapy. The median survival time of 57 patients was i4- &on& and overall actuarial survive rates at 1 and 2 years were 57.5% and 30% respectively. The partial and complete responders from induction chemotherapy showed significantly better survival (61% of 1 year and 43% of 2 year) than non-responders. And maintenance chemotherapy group showed significantly better survival than observation group (p=O.O026).Radiation pneumonitis was noted in 3 patients between 2 and 4 months after the completion of the radiotherapy. But none of these patients had continuous symptom after steroid treatment. Conclusion : All patients tolerated hyperfractionated radiotherapy and MVP chemotherapy without definite increase of romplications compared with conventional treatment. Although we included the more advanced patients with involvement of supraclavicular lymph nodes and pleural effusion in this study, this aggressive regimen produced a high rate of locoregional response and the 1 and 2 year survival were comuarable to the most active multimodalitv reeimens rewrted in locallv advanced NSCLC. The reswnders from induction chemotherapy esiecially who were allocated to the minteunance chemotherapy g&u showed significantly getter survival. So, it is worthwhile to continue combination treatment of radiotherapy and chemotherapy. But tKe sequence of radiation and chemotherapy and optimum total radiation dose will be further studied.

1065 RADIATION THERAPY FOR PRIMARY TRACHEAL CARCINOMA. A RETROSPECTIVE STUDY OF 106 CASES. F. Morn&,

R. Coquardl, P. Maingor?, S. Danhie2,

GE1 Husseini’, P. Van Houtd.

1: Cenm Uon B&ard, Lyon, France. 2: Centre Georges FranGois Lecle.rc, Dijon, France. 3: In&tot Jules Bordet, Bruxelles, Belgique. Purpose: Phmy tracheal carcinoma is a rare malignancy of the respiratory tract, which is of@ diagnosed at an advanced stage. Surgery, when feasible, remains the elective treatment. Radiation therapy is often used, following resection or as a definitive treatment, but large reports on its role are rare. The purpose of this work is to evaluate the role of radiation on local control and survival, either as post-operative adjuvant therapy or as a sole therapy for inoperable patients, based on a large series of patients. Materials & Methods: We report a ties of 106 patients presenting with a primary @acheal carcinoma (90 males, 16 females, mean age 61 years) irradiated between 1%3- 1992 in 3 institutions. Seventy four patients had an squamous cell carcinoma, 3 adenoyd cystic carcinomas. The most common symptoms were dyspnea, hemoptysis and cough. Treatment consisted of radiation in 98 patients, and surgical resection followed by radiation in 6 patients (only 4 microscopic complete resections); 2 patients received radiation for a local relapse; high dose rate brachytberapy was used as a boost in 3 patients, 9 patients received different regimens of chemotherapy. All patients received megavoltage radiation, with a mean dose of 54 Gy (8-70). The mean follow-up was 141 months (3-336). The overall survival at 1,2 , 5 years is 43%,26%, 13%, the median survival is 10 months. An objective response after radiation was observed in 76/ 100 patients, with 45% complete response.. The radiation dose appears to be an important prognostic factor ( 5-year survival of 35% if dose > 65 Gy versus 5% if dose < 65 Gy, pcO.0001; 5-year survival of 17% if dose > 54 Gy, median dose, versus.796 if dose < 54 Gy, p 65 Gy versus 37% if dose < 65 Gy (p&.02). Conversely, histology and location are not significant prognostic factors. We observed 3 toxic deaths (2 tracheal necrosis, 1 aplasia), 1 localized tracheal necrosis, 1 myelitis. Dysphagia was the most common radiation side dfect. Relapses were local, most of the time. A multivariate analysis is being performed.