Outcomes of concurrent chemoradiotherapy in patients with stage III non-small-cell lung cancer and significant comorbidity.
BACKGROUND
published trials of concurrent chemoradiotherapy (CCRT) in stage III non-small-cell lung cancer (NSCLC) generally excluded patients with significant comorbidity. We evaluated outcomes in patients who were selected by using radiation planning parameters and were considered, despite comorbidity, fit enough to receive cisplatin-based chemotherapy.


METHODS
from 2003 to 2008, 89 patients with stage III NSCLC fit to receive cisplatin-based chemotherapy and a V(20) <42% underwent CCRT at one center outside clinical trials. Most received one cycle of cisplatin-gemcitabine, followed by two to three cycles of cisplatin-etoposide concurrent with involved-field thoracic radiotherapy between 46 and 66 Gy.


RESULTS
median age was 64 years; performance status (PS) of zero, one or two in 20/64/5 patients; one or more comorbidities in 41.6%; 14% were treated previously for NSCLC. Median V(20) was 26.6% (range 4%-39.4%). Grade III esophagitis and pneumonitis occurred in 28.1% and 7.9% of patients, respectively, while 4.5% died during treatment. Median overall survival was 18.2 months [95% confidence interval (CI) 13.1-23.3 months]. Independent prognostic factors for overall survival were PS (0 versus ≥ 1, P = 0.041) and planning target volume (P = 0.022).


CONCLUSIONS
patients with significant comorbidity who are fit to undergo cisplatin-based CCRT achieve median survivals similar to that reported in phase III trials and with relatively few late toxic effects.
Phernambucq
E C J
ECJ
Department of Pulmonary Diseases. Electronic address: E.Phernambucq@vumc.nl.
Spoelstra
F O B
FOB
Department of Radiotherapy, VU University Medical Center, Amsterdam.
Verbakel
W F A R
WFAR
Department of Radiotherapy, VU University Medical Center, Amsterdam.
Postmus
P E
PE
Department of Pulmonary Diseases.
Melissant
C F
CF
Department of Pulmonary Diseases, Spaarne Hospital, Hoofddorp.
Maassen van den Brink
K I
KI
Department of Pulmonary Diseases, Waterland Hospital, Purmerend.
Frings
V
V
Department of Radiotherapy, VU University Medical Center, Amsterdam.
van de Ven
P M
PM
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
Smit
E F
EF
Department of Pulmonary Diseases.
Senan
S
S
Department of Radiotherapy, VU University Medical Center, Amsterdam.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015897:Comorbidity; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
D003841:Deoxycytidine; D005047:Etoposide; D002945:Cisplatin; D000093542:Gemcitabine