Radiotherapy with or without concomitant chemotherapy as Pre- or postoperative therapy in Non-small cell lung cancer

Abstract

Introduction: Recently, it has been shown that in patients with unresectable non-small cell lung cancer, a short course of cisplatin and vinblastine prior to radiation significantly improves median survival and doubles the number of long- term survivors, as compared with radiation therapy alone. This combined strategy appears to produce a modest but definite improvement in unresectable lung cancer. Thus, the use of combined modality treatment in patients eligible for resection might have the ability to produce survival benefits. Objectives: The goals are to assess the feasibility and toxicity of the combined regimen and to evaluate its ability to improve local control and quality of life by compressing the duration of treatment. Methods: A randomized prospective pilot study using conventional radiation therapy with or without concomitant cisplatinum and etoposide as an adjuvant treatment in patients who have undergone resection as well as initial therapy for those with marginally resectable disease. Forty two patients (25 men, 17 women) participated in this study. All patients had histopathologically proven non-small cell lung cancer. Their median age was 54 years (ranged between 33 and 63 years). No one experienced loss of appetite or significant weight loss. All patients had stage II B or IIIA disease. Group A (21 patients): Those with marginally resectable disease received two cycles of chemotherapy preoperatively and a maximum of four cycles post-operatively. Patients with initially resectable tumors received four cycles postoperatively. Radiation therapy was begun on day 1 or 2 concomitantly with chemotherapy. Group B (21 patients): They received radiotherapy without chemotherapy. Patients were equally distributed between both groups as regards the age, sex and tumor resectability. Results: Group A (concomitant chemo-radiotherapy): Two patients developed marked degrees of toxicity severe enough to discontinue chemotherapy. They were shifted to the other group. The final number became 19 patients. Otherwise, the toxicity of chemotherapy was acceptable. Temporary discontinuation was necessary for fungal sinusitis in a diabetic case. Group B: 21 patients increased to 23 after shift of these two from group A. One patient developed constrictive pericarditis, two pericardial effusions and one case had radiation pneumonitis. Patients with initially resectable tumors underwent complete resection combined with either chemo-radiation therapy or radiation therapy alone, Eighteen out of 19 receiving cisplatinum and etoposide plus radiation remain alive at the end of therapy compared with 21 out of 23 patients of group B. First year survival rates among group A and group B were 84% (16/19) and 82% (19/23) respectively. Third year survival rates were 78% (15/19) and 62% (15/23). Five year survival rates were 68% (13/19) and 39% (9/23) respectively, (P value = 0.001). Mean hospital stay for initial tri-modality treatment was shorter for patients in group A. Conclusion: Concomitant chemotherapy and radiotherapy regimen is feasible and reproducible. It is more effective as adjuvant treatment in non-small cell lung cancer than radiotherapy alone. © 2012 Elayouty HD, et al.