Chemotherapy Plus Twice Daily Radiation Therapy Increases Survival for Patients with NSCLC

The addition of cisplatin (Platinol) and oral etoposide (VePesid)to radiation therapy delays distant metastasis, thus increasingsurvival of patients with inoperable non-small-cell lung cancer,a comparison of RTOG 91-06 to RTOG 83-11 shows.

The 2-year survival of patients who were treated with chemotherapyand radiation therapy was 36%, said Dr. Ritsuko Komaki, co-chairof RTOG 91-06. That compares to 22% for patients treated withhyperfractionated radiation therapy alone.

Patients treated with combined therapy had either stage IIIa orIIIb or medically inoperable stage II non-small-cell lung cancer.They were given 50 mg/m² of cisplatin on days one and eightof treatment. They also were given oral etoposide (50 mg bid)on days 1 through 14. The chemotherapy regimen was repeated onday 29. Radiation treatments were started within 96 hours of chemotherapy,to a total dose of 69.6 Gy in 58 fractions over 29 days, 2 fractionsper day, at least 6 hours apart. Patients treated with radiationtherapy alone had similar nodal stage distribution, but somewhatsmaller tumors. The radiation treatments were the same as forpatients treated with combined therapy.

The rates of life-threatening nonhematologic toxicity were similarfor both groups of patients (2.6% for the combined treatment;3.0% for radiation therapy alone). However, there was a significantlyhigher rate of hematologic toxicity in the combined-therapy group--57%of the group suffered grade 4 hematologic toxicity, said Dr. Komaki.

Three patients in the combined group had treatment- related deaths(two pulmonary and one renal). One patient treated with radiationtherapy alone had fatal esophageal toxicity. Toxicity is a majorchallenge, said Dr. Komaki. "We are trying to reduce it byslightly reducing the drug dosage and, in the future, by 3-D conformalradiation therapy," she said.

This combination of drugs given concurrently with radiation therapyis being tested in RTOG 94-10 against standard therapy (inductioncisplatin and vinblastine followed by radiation therapy.