Concurrent chemoradiotherapy with low dose weekly gemcitabine in stage III non-small cell lung cancer.
BACKGROUND
Combined chemoradiotherapy (CRT) is the treatment of choice for stage III NSCLC. Gemcitabine (G) is a novel deoxycitidine analogue that has been proven to be a potent radiosensitizer. Twenty-two consecutive patients were treated with concurrent CRT to demonstrate the tolerability and efficacy of low dose G given weekly as radiosensitizer in stage III NSCLC.


METHODS
Patients with KPS >or=70, adequate bone marrow reserve, with no prior radiotherapy (RT) and surgery were included. Eighteen patients had received prior induction chemotherapy (CT). G (75 mg/m2/week) was infused over 1 hour for 6 weeks. Thoracic RT was given two hours later over 6 weeks at 1.8 Gy/day fractions (total dose of 61.2 Gy). Pulmonary toxicity was evaluated with computed tomography scans in 6 weeks.


RESULTS
Median age was 60 years (range, 48-75), median follow-up was 15 months (range, 2-40). Sixty-eight percent of patients were male and median KPS score was 90. Conformal 3D-RT planning was used in 64% of patients. G was given for a median of 5 weeks (range 1-9). Twelve patients (54.6%) received all planned CT. G was stopped because of intolerance in 6 and death in 2 patients. Seven patients (31.8%) had radiation pneumonitis. Twenty patients were evaluated for overall response, 1 patient (4.5%) had clinical CR, 81.8% had PR while 9.5% had SD. Median overall survival (OS) was 14 +/- 5 months (95% CI 3-25). One- and 2-year OS rates were 55% and 38%. Sixteen patients died of disease-related events (6 with progression of primary tumor, 8 due to metastatic disease), 2 patients died of other causes. One- and 2-year progression-free survival and local control rates were 56%, 27% and 79%, 51%, respectively.


CONCLUSIONS
G might be used as radiosensitizer for patients with stage III NSCLC who could not receive full doses CT with concurrent RT.
Abacioglu
Ufuk
U
Department of Radiation Oncology, Marmara University Medical School Hospital, Istanbul, Turkey. ufuk@abacioglu.com
Yumuk
Perran F
PF
Caglar
Hale
H
Sengoz
Meric
M
Turhal
Nazim S
NS
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001854:Bone Marrow Cells / Q000166:cytology / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011838:Radiation-Sensitizing Agents / Q000494:pharmacology; D020266:Radiotherapy, Conformal; D013997:Time Factors; D016896:Treatment Outcome; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D000093542:Gemcitabine