Efforts to Prevent Radiation Esophagitis, Pneumonitis May Yield Better Outcomes

SEATTLE-Concurrent chemoradiotherapy improves survival time in non-small-cell lung cancer (NSCLC) but toxicity is higher, and survival worsens if treatment breaks are required. Approaches that limit radiationinduced esophagitis and pneumonitis might translate into better outcomes for NSCLC patients. Vivek Mehta, MD, a radiation oncologist at the Swedish Cancer Institute, Seattle, Washington, and investigators in the Community Trial Non-Small-Cell Lung Cancer Group are launching an open- label trial to test the effectiveness of amifostine(Drug information on amifostine) (Ethyol) for preventing these problems in patients with unresectable stage IIIA/IIIB NSCLC who are receiving weekly chemotherapy plus daily radiotherapy. "Without cytoprotection, the V20-the percentage of lung receiving over 20 Gy of radiation- predicts the risk of radiation pneumonitis, as does the volume received over 30 Gy," Dr. Mehta said (see Figure 1). "There is a line you can draw such that the risk of radiation pneumonitis is fourfold higher if 18% or more of lung volume receives over 30 Gy." Cytoprotection With Amifostine
A study by Komaki et al suggested benefit from the addition of amifostine to chemoradiation with cisplatin(Drug information on cisplatin) (Platinol) and etoposide(Drug information on etoposide) (VePesid) in patients with inoperable stage II or III NSCLC.[1] Dr. Mehta said the trend did not reach significance, perhaps because the patients were not followed for a long enough period of time. The new open-label multicenter trial will enroll 350 patients with metastatic, unresectable stage IIIA or IIIB NSCLC. All patients will receive 3D conformal radiotherapy in conventional daily fractions of 1.8 to 2.0 Gy/d to a total dose of 60 to 70 Gy. The chemotherapy regimen during radiotherapy can either be cisplatin/etoposide or car- boplatin (Paraplatin)/paclitaxel. Following completion of chemotherapy, patients can then receive adjuvant consolidative docetaxel(Drug information on docetaxel) (Taxotere) at the investigators' dis- cretion. Amifostine will be given at 500 mg/d prior to radiation. "Our primary objective is to determine the incidence of acute esophagitis, acute pneumonitis, and chronic pneumonitis," Dr. Mehta said. "A secondary objective is to describe the changes in pulmonary function as measured by DLCO [carbon monoxide diffusing capacity] and FEV1 [forced expiratory volume in 1 second] in patients treated with concurrent chemoradiotherapy."