Novel Chemoradiotherapy Regimens for the Treatment of NSCLC Patients
Purpose: To evaluate objective response, toxicity and overall survival of stage IIB - III NSCLC patients treated with concomitant chemoradiotherapy. Material and methods: 81 patients with inoperable NSCLC and Karnovsky index more then 70% were evaluated. Patients received the following chemo regimens: Gemzar and Cisplatin - 27 pts, Taxotere and Cisplatin or Carboplatin - 26 pts and Taxol + Carboplatin 28 pts together with concomitant radiotherapy (RT). RT was done also in three different modes: standard (2-2.5 Gy) with treatment duration of 6-6.5 weeks - 30 pts, dynamic hyperfractionation (1.2-1.35 Gy, 2-3 times a day) with treatment duration of 4.5-5 weeks-36 pts, and regular hyperfractionation (1.5 Gy bid) - 15 pts. Results: Chemoinfusion was modified in 25 pts due to hematologic toxicity. Planned RT schedule was modified in 28 (34.6 %) pts out of 81. 94 % of patients developed oesophagitis Gr. I-III, but only for 9 pts out of 76 RT was temporary interrupted. Overall response was evaluated with mediane of 1.1 month after the treatment in 72 pts. 42 pts received 2-3 cycles of consolidation platinum-based chemotherapy and 30 went to follow up arm. Overall survival was 17.0 months with consolidation chemotherapy and 10.0 months in follow-up group. Conclusion: Concomitant chemoradiotherapy was well tolerated with better overall survival in the group with consolidation therapy. This method is still a standard of care for inoperable NSCLC but lots of questions are still upfront - timing, chemo regimens, radiation volume and doses of RT.