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.
Department of Radiation Oncology, Marmara University Medical School Hospital, Istanbul, Turkey. ufuk@abacioglu.com
Ufuk
U
Abacioglu
Perran F
PF
Yumuk
Hale
H
Caglar
Meric
M
Sengoz
Nazim S
NS
Turhal
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