The addition of cisplatin (Platinol) and oral etoposide (VePesid)
to radiation therapy delays distant metastasis, thus increasing
survival 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 chemotherapy
and radiation therapy was 36%, said Dr. Ritsuko Komaki, co-chair
of RTOG 91-06. That compares to 22% for patients treated with
hyperfractionated radiation therapy alone.
Patients treated with combined therapy had either stage IIIa or
IIIb or medically inoperable stage II non-small-cell lung cancer.
They were given 50 mg/m² of cisplatin on days one and eight
of treatment. They also were given oral etoposide (50 mg bid)
on days 1 through 14. The chemotherapy regimen was repeated on
day 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 fractions
per day, at least 6 hours apart. Patients treated with radiation
therapy alone had similar nodal stage distribution, but somewhat
smaller tumors. The radiation treatments were the same as for
patients treated with combined therapy.
The rates of life-threatening nonhematologic toxicity were similar
for both groups of patients (2.6% for the combined treatment;
3.0% for radiation therapy alone). However, there was a significantly
higher 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 radiation
therapy alone had fatal esophageal toxicity. Toxicity is a major
challenge, said Dr. Komaki. "We are trying to reduce it by
slightly reducing the drug dosage and, in the future, by 3-D conformal
radiation therapy," she said.
This combination of drugs given concurrently with radiation therapy
is being tested in RTOG 94-10 against standard therapy (induction
cisplatin and vinblastine followed by radiation therapy.