[Weekly paclitaxel and carboplatin with concurrent three dimensional conformal radiotherapy for locally advanced non small cell lung cancer].

OBJECTIVE: To evaluate the toxicity and efficacy of weekly chemotherapy of paclitaxel and carboplatin with concurrent three dimensional conformal radiotherapy (3D-CRT)for locally advanced non small cell lung cancer(NSCLC).

METHODS: From July 2002 to July 2004, a non-randomized prospective study of 52 patients with locally advanced NSCLC treated with 3D-CRT and chemotherapy by paclitaxel and carboplatin were carried out. Of the 52 patients, 21 received concurrent chemoradiation with 3D-CRT and weekly paclitaxel and carboplatin (concurrent chemoradiation group), 31 received sequential chemoradiation with paclitaxel and carboplatin and 3D-CRT (sequential chemoradiation group). In the concurrent chemoradiation group, paclitaxel 40 mg/m2 was administered intravenously for 1 hour. Carboplatin of 1.5 AUC/cycle was used after administration of paclitaxel on D1, D8, D15, D29, D36 and D143. In the sequential chemoradiation group, two cycles of chemotherapy were given at two weeks before radiotherapy. Paclitaxel 150 mg/m2 and carboplatin 5 AUC/cycle were administered on D1 and D21. 3D-CRT was given at two weeks after the second cycle of chemotherapy provided that the hematological examination was normal. 3D-CRT was given at 1.8-2.0 Gy/f to a total dose of 60-66 Gy/6-8 weeks.

RESULTS: All the patients completed the trial, but 12 had prolongation of treatment time for more than 1 week due to severe leucopenia with 5 in concurrent chemoradiation group and 7 in sequential chemoradiation group. The rate of complete response (CR), partial response (PR), progress of disease (NC + PD) and overall response was 9.5% (2/21), 71.4% (15/21), 19.0% (4/21) and 81.0%, respectively, in concurrent group, versus 6.5% (2/31), 67.7% (21/31), 25.8% (8/31) and 74.2% in sequential group (CR), respectively. II-III grade of esophagitis, pneumonia and leukocytopenia observed in concurrent chemoradiation group was 61.9% (13/21), 41.9% (13/31) and 23.8% (5/21) ,versus 22.6% (7/31), 42.9 % (9/21) and 19.4% (6/31), respectively, in the sequential chemoradiation group. One of those patients in concurrent chemoradiation group had IV grade of leukocytopenia. The overall median survival time was 17.5 months with 19.0 months for concurrent chemoradiation group, 15.8 months for sequential chemoradiation group. The Overall 1-, 2-year survival rate was 72.0%, 37.0%, respectively and 1 - and 2 - year local control rate was 75.0% and 75.0%.

CONCLUSION: Our data indicate that concurrent chemoradiotherapy is safe and effective for locally advanced non small cell lung cancer. Concurrent chemoradiotherapy may be helpful in improving response and survival than sequential one, but no significant difference is observed between two groups in this series(P > 0.05). Further randomized prospective study is still needed to prove it.