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

The addition of cisplatin(Drug information on cisplatin) (Platinol) and oral etoposide(Drug information on 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(Drug information on vinblastine) followed by radiation therapy.