Definitive chemoradiotherapy in Stage III nonsmall cell lung cancer: Turkey experience
Ufuk Yilmaz1, Ulku Yılmaz2, Zehra Yasar3, Esra Korkmaz Kıraklı4, Sukran Ulger5, Yasemin Ozdogan1, Nilgun Yilmaz Demirci6, Serhat Erol1, Ilker Ozdogan4, Burcu Sahin7, Deniz Koksal8, Cimen Akcay4
1 Department of Chest Diseases, Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
2 Department of Chest Diseases, Atatürk Chest Disease and Surgery Training and Research Hospital, Ankara, Turkey
3 Department of Chest Diseases, Abant Izzet Baysal University School of Medicine, Bolu, Turkey
4 Department of Radiation Oncology, Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
5 Department of Radiation Oncology, Gazi University School of Medicine, Ankara, Turkey
6 Department of Chest Diseases, Gazi University School of Medicine, Ankara, Turkey
7 Department of Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
8 Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Department of Chest Diseases, Abant Izzet Baysal University School of Medicine, Golkoy, Bolu
Source of Support: None, Conflict of Interest: None
Aim: Concurrent chemoradiotherapy (CRT) is the standard therapy for patients with unresectable Stage III nonsmall cell lung cancer (NSCLC). The aim of this study was to assess the efficacy and safety of concurrent CRT in unresectable Stage III NSCLC in Turkey.
Patients and Methods: The study included 82 patients with histologically proven unresectable Stage III NSCLC, Eastern Cooperative Oncology Group performance status 0–1, who received concurrent CRT in two different referral centers. Treatment consisted of two cycles of cisplatin at 50 mg/m 2 on days 1, 8, 29, and 36 and etoposide 50 mg/m 2 between days 1 and 5, 29–33 and concurrent radiotherapy administered once daily, 1.8–2.0 Gy per fraction, at a total dose of 60–66 Gy.
Results: The stages of the patients were Stage IIIA in 39 (47.5%) and IIIB in 43 (52.5%) patients. Complete and partial responses were achieved in 15 (18.2%) and 31 (37.8%) of the patients, respectively. Twenty-eight (34.2%) patients had stable disease and 8 (9.8) had progressive disease. Forty-one (50%) patients recurred during follow-up. The primary site of recurrence was as distant metastasis in 19 (23.2%) patients. Median overall survival (OS) was 20 months (95% confidence interval; 12.9–27.09 months), 3 and 4 years survivals were 27.9% and 20.9%, respectively. Median progression-free survival (PFS) was 9 months, 3 and 4 years PFSs were 20.1% and 16.1%. Myelosuppression was the most common toxicity. In 15 (19.2%) patients grade 2–3 lung toxicity and in seven (8.5%) patients' grade 2–3 dysphagia were reported.
Conclusion: Concurrent CRT with cisplatin and etoposide schedule is a well-tolerated regimen with acceptable toxicity profile and survival rates in patients with unresectable Stage IIIA/IIIB NSCLC. Median survival and OS results were consistent with the literature.