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Original Article
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Dose-escalating conformal thoracic radiation therapy with induction and concurrent carboplatin/paclitaxel in unresectable stage IIIA/B nonsmall cell lung carcinoma
A modified phase I/II trial
Article first published online: 18 SEP 2001
DOI: 10.1002/1097-0142(20010901)92:5<1213::AID-CNCR1440>3.0.CO;2-0
Copyright © 2001 American Cancer Society
Additional Information
How to Cite
Socinski, M. A., Rosenman, J. G., Halle, J., Schell, M. J., Lin, Y., Russo, S., Rivera, M. P., Clark, J., Limentani, S., Fraser, R., Mitchell, W. and Detterbeck, F. C. (2001), Dose-escalating conformal thoracic radiation therapy with induction and concurrent carboplatin/paclitaxel in unresectable stage IIIA/B nonsmall cell lung carcinoma. Cancer, 92: 1213–1223. doi: 10.1002/1097-0142(20010901)92:5<1213::AID-CNCR1440>3.0.CO;2-0
Publication History
- Issue published online: 18 SEP 2001
- Article first published online: 18 SEP 2001
- Manuscript Accepted: 4 JUN 2001
- Manuscript Received: 24 APR 2001
Funded by
- Bristol-Meyers Squibb Oncology
- Abstract
- Article
- References
- Cited By
Keywords:
- locally advanced nonsmall cell lung carcinoma;
- combined modality therapy;
- carboplatin;
- paclitaxel;
- thoracic radiation therapy;
- conformal treatment planning;
- lung carcinoma
Incorporation of three-dimensional conformal treatment planning in the combined modality approach to unresectable Stage IIIA/B nonsmall cell lung carcinoma using sequential and concurrent carboplatin/paclitaxel is feasible and allows dose escalation of the thoracic radiation therapy dose to 74 gray. The toxicity profile of this approach is acceptable and the survival results are encouraging.
Abstract
BACKGROUND
A modified Phase I/II trial was conducted evaluating the incorporation of three-dimensional conformal radiation therapy into a strategy of sequential and concurrent carboplatin/paclitaxel in Stage III unresectable nonsmall cell lung carcinoma (NSCLC). The dose of thoracic conformal radiation therapy (TCRT) from 60 to 74 gray (Gy) was increased. Endpoints included response rate, toxicity, and survival.
METHODS
Sixty-two patients with unresectable Stage III NSCLC were included. Patients received 2 cycles of induction carboplatin (area under the concentration curve [AUC], 6) and paclitaxel (225 mg/m2 over 3 hours) every 21 days. On Day 43, concurrent TCRT and weekly (×6) carboplatin (AUC, 2) and paclitaxel (45 mg/m2/3 hours) were initiated. The TCRT dose was escalated from 60 to 74 Gy in 4 cohorts (60, 66, 70, and 74 Gy).
RESULTS
The response rate to induction carboplatin/paclitaxel was 40%. Eight patients (13%) progressed on the induction phase. No dose-limiting toxicity was observed during the escalation of the TCRT dose from 60 to 74 Gy. The major toxicity was esophagitis, however, only 8% developed Grade 3/4 esophagitis using Radiation Therapy Oncology Group criteria. The overall response rate was 52%. Survival rates at 1, 2, 3, and 4 years were 71%, 52%, 40%, and 36%, respectively, with a median survival of 26 months. The 1-, 2-, and 3-year progression free survival probabilities were 47%, 35%, and 29%, respectively.
CONCLUSIONS
Incorporation of TCRT with sequential and concurrent carboplatin/paclitaxel is feasible, and dose escalation of TCRT to 74 Gy is possible with acceptable toxicity. Overall response and survival rates are encouraging. Both locoregional and distant failure remain problematic in this population of patients. Cancer 2001;92:1213–23. © 2001 American Cancer Society.