title: Comparison of toxicity and outcomes of concurrent radiotherapy with carboplatin/paclitaxel or cisplatin/etoposide in stage III non-small cell lung cancer.
abstract: Concurrent chemoradiotherapy (CCRT) has become the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). The comparative merits of two widely used regimens: carboplatin/paclitaxel (PC) and cisplatin/etoposide (PE), each with concurrent radiotherapy, remain largely undefined. Records for consecutive patients with stage III NSCLC treated with PC or PE and ≥60 Gy chest radiotherapy between 2000 and 2011 were reviewed for outcomes and toxicity. Survival was estimated using the Kaplan-Meier method and Cox modeling with the Wald test. Comparison across groups was done using the student's t and chi-squared tests. Seventy-five (PC: 44, PE: 31) patients were analyzed. PC patients were older (median 71 vs. 63 years; P = 0.0006). Other characteristics were comparable between groups. With PE, there was significantly increased grade ≥3 neutropenia (39% vs. 14%, P = 0.024) and thrombocytopenia (10% vs. 0%, P = 0.039). Radiation pneumonitis was more common with PC (66% vs. 38%, P = 0.033). Five treatment-related deaths occurred (PC: 3 vs. PE: 2, P = 1.000). With a median follow-up of 51.6 months, there were no significant differences in relapse-free survival (median PC 12.0 vs. PE 11.5 months, P = 0.700) or overall survival (median PC 20.7 vs. PE 13.7 months; P = 0.989). In multivariate analyses, no factors predicted for improved survival for either regimen. PC was more likely to be used in elderly patients. Despite this, PC resulted in significantly less hematological toxicity but achieved similar survival outcomes as PE. PC is an acceptable CCRT regimen, especially in older patients with multiple comorbidities.
authors.affiliation: Austin-Ludwig Oncology Unit, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, Australia; Ludwig Institute for Cancer Research, Olivia Newton-John Cancer & Wellness Centre, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
authors.forename: Mun Sem
authors.initials: MS
authors.lastname: Liew
authors.forename: Joseph
authors.initials: J
authors.lastname: Sia
authors.forename: Maud H W
authors.initials: MH
authors.lastname: Starmans
authors.forename: Ali
authors.initials: A
authors.lastname: Tafreshi
authors.forename: Sam
authors.initials: S
authors.lastname: Harris
authors.forename: Malcolm
authors.initials: M
authors.lastname: Feigen
authors.forename: Shane
authors.initials: S
authors.lastname: White
authors.forename: Allan
authors.initials: A
authors.lastname: Zimet
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
authors.forename: Paul C
authors.initials: PC
authors.lastname: Boutros
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Thomas
authors.initials: T
authors.lastname: John
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents; D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin
keywords: Carboplatin/paclitaxel; cisplatin/etoposide; concurrent chemoradiotherapy; locally advanced; non-small cell lung cancer; stage III