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Toxicity and outcome of a phase II trial of taxane‐based neoadjuvant chemotherapy and 3‐dimensional, conformal, accelerated radiotherapy in locally advanced nonsmall cell lung cancer
Author(s) -
Rojas Ana M.,
Lyn Basil E.,
Wilson Elena M.,
Williams Frances J.,
Shah Nihal,
Dickson Jeanette,
Saunders Michele I.
Publication year - 2006
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22123
Subject(s) - medicine , carboplatin , radiation therapy , chemotherapy , pneumonitis , taxane , surgery , lung cancer , adverse effect , oncology , cancer , lung , breast cancer , cisplatin
BACKGROUND The objective of this study was to evaluate prospectively the acute and late adverse effects of taxane/carboplatin neoadjuvant chemotherapy and 3‐dimensional, conformal radiotherapy in patients with locally advanced nonsmall cell lung cancer (NSCLC). METHODS Forty‐two patients were entered into a nonrandomized Phase II study of continuous, hyperfractionated, accelerated radiotherapy (CHART) week‐end less (CHARTWEL) to a dose of 60 grays (Gy). Three cycles of chemotherapy were given over 9 weeks before radiotherapy. Dose escalation with paclitaxel was from 150 mg/m 2 to 225 mg/m 2 . Systemic toxicity to chemotherapy was monitored throughout. Radiation‐induced, early, adverse effects were assessed during the first 9 weeks from the start of radiotherapy, and late effects were assessed from 3 months onward. Overall survival, disease‐free survival, and locoregional tumor control also were monitored. RESULTS Twenty percent of patients failed to receive chemotherapy as planned, primarily because of neutropenia. The incidence of Dische Dictionary Grade ≥2 and Grade ≥3 dysphagia was 57.5% and 10%, respectively, with an average duration of 1.2 weeks and 1.5 days, respectively. By 9 weeks, <3% of patients were symptomatic; and, eventually, all acute reactions were healed, and there has been no evidence of consequential damage. At 6 months, the actuarial incidence of moderate‐to‐severe pneumonitis was 10%. During this time, all patients were free of severe pulmonary complications. Actuarial estimates of Grade ≥2 late lung dysfunction were 3% at 1 year, 10% at 2 years, and remained at this level thereafter. The actuarial 3‐year locoregional control and overall survival rates were 54% and 45%, respectively. CONCLUSIONS Neoadjuvant chemotherapy followed by 3‐dimensional, conformal CHARTWEL 60‐Gy radiotherapy in patients with advanced NSCLC was feasible and was tolerated well. Historic comparisons indicated that locoregional tumor control is not compromised by the use of conformal techniques. Cancer 2006. © 2006 American Cancer Society.