Cisplatin-Docetaxel Induction plus Concurrent 3-D Conformal Radiotherapy and Weekly Chemotherapy for Locally Advanced Non-Small Cell Lung Cancer Patients: A Phase II Trial

Abstract

Concurrent chemoradiotherapy (CHRT) is the standard of care for unresectable locally advanced stage III non-small cell lung cancer. However, the optimal combination remains unclear. The aim of this study was to evaluate the efficacy of 2 induction chemotherapy cycles (days 1 and 22) with docetaxel 75 mg/m² and cisplatin 75 mg/m² followed by concurrent chemotherapy (weekly docetaxel-cisplatin, 20 mg/m²) and 3-D conformal radiotherapy for 6 weeks (66 Gy/5 fractions per week/2 Gy per fraction). The primary endpoint was the response rate. Secondary objectives were toxicity, time to progression, and overall survival. Forty-four patients were included and 40 were eligible. The mean age was 60.5 years (range 40.7–72.1), and 75% had stage IIIB disease. Six patients underwent complete R0 resection including 2 pathologic complete responses after a planned intermediate evaluation. Thirty-three patients completed CHRT. The objective response rate was 65% (95% CI 50.2–79.8). Grade 3–4 hematologic and digestive toxicities were observed mainly during the induction phase. Grade 3 esophagitis (5%) was experienced during CHRT. With a median follow-up of 38.7 months, the median progression-free survival was 28.3 months (95% CI 11.0–35.0) and the median survival rate was 31.4 months. Cisplatin-docetaxel induction followed by concurrent 3-D conformal radiotherapy and weekly chemotherapy is a feasible protocol associated with a promising response rate and acceptable toxicity.

Sequential Chemoradiotherapy with Accelerated Hypofractionated Radiotherapy Compared to Concurrent Chemoradiotherapy with Standard Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer

“…With the development of radiation techniques, however, renewed enthusiasm is being given to hypofractionation. In the present study, the toxicity profile of our CCRT (with standard RT) cohort paralleled other studies with similar the raputic protocols (15)(16)(17)(18). Although concurrent CHT studies have found that weekly docetaxel and cisplatin was associated with relatively low toxicity and good compliance (4), in our study toxicities were significantly worse when compared with the SCRT group.…”

Long term efficacy and toxicity after stereotactic ablative reirradiation in locally relapsed stage III non-small cell lung cancer

“…A second relapse was treated with a second course of SABR for 2 patients while all other relapsed patients were treated with systemic treatment. Seven patients got less than 60 Gy during previous irradiation but were still treated with curative intent because eventually underwent surgery after chemoradiotherapy, due to very good response [21].…”

Thoracic Vertebral Body Irradiation Contributes to Acute Hematologic Toxicity During Chemoradiation Therapy for Non-Small Cell Lung Cancer

“…In total, 48 patients were excluded because of a chemotherapy regimen other than carboplatin–paclitaxel (n=30), use of colony-stimulating factors (n=8), or treatment with RT alone (n=10). Patients who received induction chemotherapy (32%) and had adequately recovered their blood counts before starting CRT were included on the basis of previous studies documenting blood cell counts during concurrent CRT to be similar to those treated with concurrent CRT alone (11–12). Patients with inoperable (owing to medical comorbidities) stage II (n=5) NSCLC treated with definitive CRT were included.…”