Preoperative concurrent chemoradiotherapy for unresectable stage III nonsmall cell lung cancer

Abstracts

1 Lung

Cancer

rate did not significantly differ in the two groups (P = .33). The hvo showed similar incidence of acute and late high-grade toxicity (P = .44 and .75, respectively). No treatment-related toxicity was observed. Conclusion: The combination of HPX RT and low-dose daily CBDCA plus VP-16 was tolerable and improved the survival of patients with stage III NSCLC as a result of improved local control. groups

Concurrent chemoradiation therapy with oral etoposide and cisplatin for locally advanced inoperable non-small-cell lung cancer: Radiation Therapy Oncology Group Protocol 91-06 Lee JS, Scott C, Komaki R, Fossella Fv, Dundas GS, McDonald S et al. Department of Thoracic/HNMo, M.D. Anderson Cancer Cente,: Box 80, ISIS Holcombe Blvd, Houston, TX 77030. J Clin Oncol 1996;14: 105564. Purpose: Patients with locally advanced inoperable non-smallcell lung cancer (NSCLC) have a poor clinical outcome. We conducted a prospective study to evaluate the merit of chemotherapy administered concurrently with hyperfractionated thoracic radiation therapy. Patients and Methods: Seventy- nine patients with inoperable NSCLC were enrolled onto a multicenter phase II trial of concurrent chemoradiation therapy. Treatment consisted of two cycles of oral etoposide 100 mg/d (50 mg twice daily) on days I to 14 of a ZSday cycle (75 mg/d if bodysurface area [BSA] < 1.70 m’), intravenous cisplatin 50 mg/m* on days I and 8, and hyperfractionated radiation therapy 5 days per week (I.2 Gy twice daily > 6 hours apart; total, 69.6 Gy). Results: Seventy-six assessable patients with a Karnofsky performance status 60 and adequate organ function who had received no prior therapy were evaluated for clinical outcome and toxic effects. After a minimum followup duration of 2 I months, the 1 - and 2-year survival rates and median survival duration were 67%, 35%. and 18.9 months overall; they were 70%. 42%, and 21.1 months for patients with weight loss of 5 5%. Toxicity was significant; 57% developed grade 4 hematologic toxicity, 53% grade 3 or 4 esophagitis, and 25% grade 3 or 4 lung toxicity. However, only 6.6% of patients had grade 4 or lethal nonhematologic toxicity. which included three treatment-related deaths (two of pneumonitis and one of renal failure). Conclusion: Concurrent chemoradiation therapy with oral etoposide and cisplatin plus hyperfractionated radiation therapy is feasible. The survival outcome from this regimen compares favorably with that of other chemoradiation trials and even of multimodality trials that have included surgery. Adjuvant chemotherapy atIer complete resection in non-smallcell lung cancer Wada H, Hitomi S. Teramatsu T. Department of Thoracic Surgery, Chest Disease Research Institute, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyoku, Kyoto 606-01. J Clin Oncol 1996;14:1048-54. Purpose: We performed a study to determine whether postoperative mild chemotherapy to maintain the patient’s quality of life (QOL) and immunoactivily could also prolong survival. Subjects and Methods: From December 1985 to July 1988, 323 patients with completely resected primary non-small-cell lung cancer (stage I to III) were enrolled. The subjects were randomized into three treatment groups, as follows: cisplatin (CDDP) 50 m&m2 body surface, vindesine (VDS) 2 to 3 mg/ kg body weight for three courses, and I-year oral administration of tegafur (FT) plus uracil (UFT) 400 m@g body weight (CWfl group, 115 patients); l-year oral administration of UFf 400 mgtkg body weight (Ufl group, 108 patients); or surgical treatment only (control group, 100 patients). Results: The overall 5-year survival rates were 60.6% for the CWft group and 64.1% for the UA group versus 49.0% for the control group. The results of statistical testing were P = .053 (log- rank test) and P - ,044 (generalized Wilcoxon test) among the three groups, P = ,083 (log-rank) and P = ,074 (Wilcoxon) between the CWft and the control groups. and P = ,022 (log-rank) and P = ,019 (Wilcoxon) between the Uft and the control groups, which indicates higher survival

15 (1996)

381-399

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rates in the CWA and the Uft groups compared with the control group. A multivariate statistical analysis oo prognostic factors using Cox’s proportional hazards model was performed with the following results: P = ,037, hazards ratio = 0.64 with a 95% confidence interval (CI) of 0.42 to 0.97 (control v CWfl group); and P = ,009, hazards ratio = 0.55 with a 95% Cl of 0.36 to 0.86 (control v Uft group). Conclusion: Significantly favorable results were obtained in the CWft and Uft groups compared with surgery alone. These data showed significant prognostic advantages in the postoperative adjuvant chemotherapy groups. Preoperative concurrent chemoradiotherapy for unresectable stage III nonsmall cell lung cancer Milstein D, Kuten A, Saute M, Best LA, Daoud K, Zen-AI-Deen I et al. Northern Israel Oncology Center, Rambam Medical Centec Haifa 31096. Int J Radiat Oncol Biol Phys 1996;34:1125-32. Purpose: We carried out a Phase II trial in an attempt to improve resectability and survivability of inoperable Stage III A and III B nonsmall cell lung cancer (NSCLC) patients by implementing a neoadjuvant chemoradiotherapy treatment program. Methods and Materials: Thirty-six patients with locally advanced Stage III NSCLC received neoadjuvant therapy consisting of 50.4 Gy in 5.5 weeks concurrent with two cycles of chemotherapy, using cisplatin and etoposide. No postsurgical consolidation therapy was given. Rex&s: Assessment at 3 to 6 weeks after treatment suggested that 26 (72%) patients had been rendered resectable. Toxicities were common but usually tolerable; however, one toxic death occurred. Of 24 patients who proceeded to thoracotomy, complete resection was achieved in 20 (56%). There were two surgically related deaths. Surgical-pathological staging showed downstaging in 18 patients, including complete sterilization of the tumor in 3 (8%). The median survival for all 36 patients is IS months, but at the time of analysis, median survival of resectable patients had not been reached. The actuarial 2-year survival is 39% for all study groups, 57% for resectable patients, and 16% for the remaining (p < 0.005). Conclusions: While this preoperative neoadjuvant appears to improve survival of patients with Stage III NSCLC. comparison with previous reports of other similar trials indicate a superior survival advantage in association with higher doses of radiotherapy. The role of adjuvant therapy in the pN2 non small cell lung cancer (NSCLC) Chella A, Lucchi M, Gragnani F, Ribechini A, Silvano G, Janni A et al. Dipartimento di Chirurgra Toracica, Universita degli Studi. Ma Roma, 67. 56100 Piss. Minerva Chir 1995;50:1029-38. Over a period of eleven years (1983-1993), the role of adjuvant chemo and/or radiotherapy was evalutated on 222 resected patients (pts) with NSCLC at atage IIIA(N2). All the patients undenvent an attentive mediastinal limphoadenectomy. Fifty-live patients had a clinical mediastinal node involvement. 174 pts had a single media&al node station involved while 48 had two or more stations involved. One hundred and seventy-one pts (77%) underwent adjuvant therapies, consisting of citotoxic chemotherapy in 40 pts, radioterhapy in 97 pts and chemoradioterhapy in 34 pts. Follow-up lasted until September 1994. Overall 5-yr survival was 17.5%, the median being 17 months. Forty-two pts were. at that moment, still living (median 43.5 months, min 1I-maw 120) with 37 disease free. We verified a significant difference concerning survival among the three histologic types (p = 0.03). with the squamous achieving the best result (21.3% at 5-yrs). Surgical N2 had a better survival (20/5% at 5-yrs) than the clinical one (9%), @ = 0.01). In particular, if only one nodal station was involved, survival was 21.3% compared to 4.5% when metastases were present at two or more nodal station (p = 0.0001). Considering the level of mediastinal node involvement, the worst prognosis was linked to the carina node metastases (p = 0.02). Survival benefits were obtained by means of