Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study

Zatloukal, Petr; Petruželka, Luboš; Zemanová, Milada; Havel, Libor; Janků, Filip; Judas, Libor; Kubík, A; Kr̆epela, E; Fiala, Pavel; Pecen, Ladislav

doi:10.1016/j.lungcan.2004.03.004

Cited by 394 publications

(195 citation statements)

References 12 publications

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“…Combined concurrent modality treatment increases long-term survival, but at the expense of a higher incidence of severe esophagitis [5][6][7][8]. In order to allow proper balancing between expected benefits and drawbacks of aggressive therapy, knowledge of the effects of a given treatment on the quality of life (QoL) is needed.…”

Section: Introductionmentioning

confidence: 99%

“…Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer is standard care for patients with locally advanced disease, i.e. stage III non-small cell lung cancer (NSCLC) or limited stage small cell lung carcinoma (LD-SCLC) [3,4].Combined concurrent modality treatment increases long-term survival, but at the expense of a higher incidence of severe esophagitis [5][6][7][8]. In order to allow proper balancing between expected benefits and drawbacks of aggressive therapy, knowledge of the effects of a given treatment on the quality of life (QoL) is needed.…”

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confidence: 99%

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High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

Pijls‐Johannesma

Houben

Boersma

et al. 2009

Radiotherapy and Oncology

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a b s t r a c tBackground and purpose: Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer leads to a high incidence of severe, mostly esophageal, toxicity. The purpose of this study was to investigate the evolution of quality of life (QoL) in patients with lung cancer, selected for curative radiotherapy (RT) or chemo-RT. Methods: Seventy-five lung cancer patients completed a longitudinal the EORTC QLQ-C30 and LC13. Linear mixed regression models were fitted to investigate the impact of different factors on overall QoL. Results: Overall QoL decreased shortly after the end of RT (4 points, p = 0.19), but increased back to baseline within 3 months. Mean scores of role functioning (p = 0.018), cognitive functioning (p = 0.002), dyspnoea (EORTC QLQ-LC13; p = 0.043), dysphagia (p = 0.005) and hoarseness (p = 0.029), showed a significant worsening over time. Emotional functioning (p = 0.033) improved significantly over time. Severe esophagitis (Pgrade 2) was reported in only 12% of the patients. Next to maximal esophageal toxicity Pgrade 2 (p = .0.010), also tumor stage IIIA (p < 0.001), tumor stage IIIB (p = 0.003), gender (p = 0.042) and fatigue (p < 0.001) appeared to be significant predictors of QoL. Conclusion: High-dose radiotherapy or concurrent chemo-radiation in the treatment of lung cancer seems to be a well-tolerated treatment option with preservation of QoL. Lung cancer remains a major public health problem worldwide because of its high incidence, rapid progression, and poor outcome [1]. The majority of patients who develop lung cancer die of this disease within a year [2]. Aggressive radiotherapy or concurrent chemo-radiation therapy for lung cancer is standard care for patients with locally advanced disease, i.e. stage III non-small cell lung cancer (NSCLC) or limited stage small cell lung carcinoma (LD-SCLC) [3,4].Combined concurrent modality treatment increases long-term survival, but at the expense of a higher incidence of severe esophagitis [5][6][7][8]. In order to allow proper balancing between expected benefits and drawbacks of aggressive therapy, knowledge of the effects of a given treatment on the quality of life (QoL) is needed.An optimal therapy could be defined as one that increases survival or provides benefit through reduction in cancer-related symptoms and improved QoL.To the best of our knowledge, in only one study, QoL assessment was performed in patients receiving high-dose radiotherapy for NSCLC [9]. No data are at present known on the influence of concurrent chemo-radiation on the QoL.Moreover, a broad Medline search using the terms ''QoL and SCLC" (December 2008) revealed only 15 studies of which none examined QoL after radiotherapy treatment.The purpose of this study was to investigate the evolution of QoL on NSCLC stages I-III and LD-SCLC patients, referred for hyperfractionated accelerated high-dose radiotherapy (RT) with or without concurrent chemotherapy, with curative intent. Since we hypothesized that QoL would be considerably influenced by esophageal...

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

Pijls‐Johannesma

Houben

Boersma

et al. 2009

Radiotherapy and Oncology

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“…Combination chemoradiation therapy has improved survival in patients with stage III inoperable non-small cell lung cancer when compared with radiation treatment alone (1)(2)(3)(4)(5)(6)(7)(8)(9). Despite the promising improvement by combined modality therapy, investigations using various chemoradiotherapy combinations have yielded an average 5-year survival of less than 25%.…”

Section: Introductionmentioning

confidence: 99%

Toxicity Profile and Pharmacokinetic Study of A Phase I Low-Dose Schedule–Dependent Radiosensitizing Paclitaxel Chemoradiation Regimen for Inoperable Non–Small-Cell Lung Cancer

Chen

Pandya

Feins

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-We report the toxicity profile and pharmacokinetic data of a schedule-dependent chemoradiation regimen using pulsed low-dose paclitaxel for radiosensitization in a phase I study for inoperable non-small cell lung cancer (NSCLC).Methods and Materials-Paclitaxel at escalating doses of 15 mg/m 2 , 20 mg/m 2 , and 25 mg/m 2 were infused on Monday, Wednesday, and Friday with daily chest radiation in cohorts of 6 patients. Daily radiation (RT) was delayed for maximal G2/M arrest and apoptotic effect, an observation from preclinical investigations. Plasma paclitaxel concentration was determined by High Performance Liquid Chromatography (HPLC).Results-Dose-limiting toxicities included 3/18 patients with grade 3 pneumonitis and 3/18 patients with grade 3 esophagitis. There was no grade 4 or 5 pneumonitis or esophagitis. There was no grade 3 or 4 neutropenia, thrombocytopenia, anemia or neuropathy. For dose levels I (15 mg/m 2 ), II (20 mg/m 2 ), and III (25 mg/m 2 ), the mean peak plasma level was 0.23 ±0.06 μM, 0.32±0.05 μM, and 0.52±0.14 μM, respectively; AUC was 0.44± 0.09 μM, 0.61± 0.1 μM, and 0.96± 0.23 μM, respectively; and duration of drug concentration above 0.05 μM (t >0.05 μM) was 1.6± 0.3 hr, 1.9± 0.2 hr, and 3.0± 0.9 hr, respectively. Conclusion-Pulsed low-dose paclitaxel chemoradiation is associated with low toxicity. Pharmacokinetic data showed that plasma paclitaxel concentration above 0.05 μM for a minimum of 1.6 hours was sufficient for effective radiosensitization.

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“…The standard treatment of locally advanced unresectable NSCLC is combined chemotherapy and thoracic radiation, based on the results of several randomised phase III trials (Schaake-Koning et al, 1992;Dillman et al, 1996;Sause et al, 2000). Subsequent trials have demonstrated the superiority of concurrent chemotherapy and radiotherapy over a sequential approach (Furuse et al, 1999;Curran et al, 2003;Zatloukal et al, 2004), although at the expense of increased toxicity, in particular severe oesophageal toxicity.…”

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confidence: 99%

Docetaxel-based induction therapy prior to radiotherapy with or without docetaxel for non-small-cell lung cancer

Scagliotti

Szczęsna²,

Ramlau³

et al. 2006

Br J Cancer

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This trial aimed to assess the feasibility and tumour control of concurrent chemoradiotherapy or radiotherapy alone after docetaxelbased induction chemotherapy in locally advanced non-small-cell lung cancer (NSCLC). Patients with stage IIIA/IIIB NSCLC received two 21-day cycles of induction chemotherapy with docetaxel (85 mg m À2 , day 1) plus cisplatin (40 mg m À2 , days 1 and 2). Patients without disease progression on day 43 were randomised to radiotherapy (2 Gy for 5 days week À1 ; total 60 Gy) alone or with docetaxel 20 mg m À2 once weekly every 6 weeks. Of 108 patients who received induction chemotherapy, 104 were evaluable for response. After induction chemotherapy, the overall response rate (ORR) was 44%; 91 (88%) patients had no disease progression and 89 were subsequently randomised to local treatment. After randomised therapy, the ORR was 53% (chemoradiotherapy 58%; radiotherapy 48%). Median survival and time to progression were 14.9 and 7.8 months, respectively, for chemoradiotherapy and 14.0 and 7.5 months, respectively, for radiotherapy. The most common toxicities during induction chemotherapy and randomised therapy were grades 3 -4 neutropenia and grade 3 lymphocytopenia, respectively. Docetaxel -cisplatin induction therapy followed by concurrent docetaxel and thoracic radiotherapy is a feasible treatment option, showing good clinical activity and tolerability, for locally advanced NSCLC.

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Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study

Cited by 394 publications

References 12 publications

High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL

Toxicity Profile and Pharmacokinetic Study of A Phase I Low-Dose Schedule–Dependent Radiosensitizing Paclitaxel Chemoradiation Regimen for Inoperable Non–Small-Cell Lung Cancer

Docetaxel-based induction therapy prior to radiotherapy with or without docetaxel for non-small-cell lung cancer

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