Limited Field Radiotherapy Concomitant with Cisplatin/Etoposide Followed by Consolidation Docetaxel for the Treatment of Inoperable Stage III Non-Small Cell Lung Cancer

Purpose: To evaluate the efficacy and outcome of concomitant cisplatin/etoposide and limited field irradiation followed by consolidation docetaxel in patients with locally advanced non small cell lung cancer (NSCLC). Patients and Methods: This is a prospective phase II study that included 32 patients with locally advanced stage III NSCLC who presented to the Radiation Oncology and Chest Departments- Ain Shams University hospitals, and Sohag Cancer Center between May 2004 and August 2006. Eligible patients were treated first with two cycles of cisplatin 50mg/m2/day on days 1, 8, 29 and 36 and etoposide 50mg/m2/day on days 1-5 and 29-33 concomitant with conventionally fractionated radiation (66Gy in 2Gy fractions) to the gross primary disease and regionally involved lymph nodes followed by 3 cycles of consolidation single agent docetaxel, 75mg/m2/3 weeks. Results: The median follow-up duration was 13.5 months (range from 6 to 30 months). The median survival was 17.4 months and the median progression free survival was 13 months. A total of 20 patients (62.5%) had treatment failure, 47% had an in field failure, 44% had distant failure, and one patient (3%) had isolated nodal failure (INF). Neutropenia (15.5%), anemia (19%), nausea and vomiting (15.5), esophagitis (9%) and pneumonitis (3%) were the most severe, grade 3 and 4, acute toxicities recorded during concomitant chemoradiation and 3 patients (9%) had grade 3 late esophagitis. Neutropenia (35%) and anemia (17%) were the most pronounced, grade 3 and 4, toxicities during consolidation chemotherapy. Conclusion: Concomitant chemoradiation, without elective nodal irradiation (ENI), is a promising approach for management of locally advanced NSCLC. Conformal irradiation with possible dose escalation may provide an