Efforts to Prevent Radiation Esophagitis, Pneumonitis May Yield Better Outcomes

SEATTLE-Concurrentchemoradiotherapy improves survivaltime in non-small-cell lungcancer (NSCLC) but toxicity ishigher, and survival worsens iftreatment breaks are required.Approaches that limit radiationinducedesophagitis and pneumonitismight translate into betteroutcomes for NSCLC patients.Vivek Mehta, MD, a radiationoncologist at the Swedish CancerInstitute, Seattle, Washington, andinvestigators in the CommunityTrial Non-Small-Cell Lung CancerGroup are launching an open-label trial to test the effectivenessof amifostine (Ethyol) for preventingthese problems in patients withunresectable stage IIIA/IIIBNSCLC who are receiving weeklychemotherapy plus daily radiotherapy.

"Without cytoprotection, theV20-the percentage of lung receivingover 20 Gy of radiation-predicts the risk of radiation pneumonitis,as does the volumereceived over 30 Gy," Dr. Mehtasaid (see Figure 1). "There is a lineyou can draw such that the risk ofradiation pneumonitis is fourfoldhigher if 18% or more of lung volumereceives over 30 Gy."Cytoprotection With Amifostine
A study by Komaki et al suggestedbenefit from the addition ofamifostine to chemoradiation withcisplatin (Platinol) and etoposide(VePesid) in patients with inoperablestage II or III NSCLC.[1] Dr.Mehta said the trend did not reachsignificance, perhaps because thepatients were not followed for along enough period of time.The new open-label multicentertrial will enroll 350 patients withmetastatic, unresectable stage IIIAor IIIB NSCLC. All patients willreceive 3D conformal radiotherapyin conventional daily fractionsof 1.8 to 2.0 Gy/d to a total dose of60 to 70 Gy. The chemotherapyregimen during radiotherapy caneither be cisplatin/etoposide or car-boplatin (Paraplatin)/paclitaxel.Following completion of chemotherapy,patients can then receiveadjuvant consolidative docetaxel(Taxotere) at the investigators' dis-cretion. Amifostine will be givenat 500 mg/d prior to radiation."Our primary objective is todetermine the incidence of acuteesophagitis, acute pneumonitis,and chronic pneumonitis," Dr.Mehta said. "A secondary objectiveis to describe the changes inpulmonary function as measuredby DLCO [carbon monoxide diffusingcapacity] and FEV1 [forcedexpiratory volume in 1 second] inpatients treated with concurrentchemoradiotherapy."

References:

1.

Komaki R, Lee RS, Kaplan B, etal: Randomized phase III study ofchemoradiation ± amifostine in patientswith inoperable stage II-III nonsmallcell lung cancer (NSCLC). Abstract1298. Proc Am Soc Clin Oncol20:325a, 2001.