Efficacy and Tolerability for Neoadjuvant Chemotherapy in Locally Advanced Non-Small Cell lung Cancer

Authors

  • Ehab Abdou Department Of Radiation Oncology, AL-Azhar University, Cairo, Egypt. Consultant Oncology Bahrain oncology center SMC, Bahrain
  • Khaled Al-Shahhat Department Of Radiation Oncology, AL-Azhar University, Cairo, Egypt
  • Mohamed Gaafar Department Of Epidemiology, Shebeen Alkoom University, Almunofyia, Egypt

Keywords:

neoadjuvant, non-small cell lung cancer, chemotherapy.

Abstract

Objective

To assess Efficacy and tolerability for neoadjuvant chemotherapy in Locally advanced non-small Cell lung cancer.

Design: retrospective study.

Patients and Methods: Between May 2011 and April 2013, 20 patients with stage III A,B Non-small cell lung cancer (NSCLC) referred to Oncology department, Salmanyia Medical Complex (SMC) were treated with combined induction chemotherapy consisting of 3 cycles of cisplatin (80 mg/m2) day I, and Gemcitabine 1250 mg/m2 by intravenous infusion day 1 and 8.

Cycles were repeated every 3 weeks. The chemotherapy was followed with thoracic irradiation starting 4-6 weeks after induction chemotherapy up to 60 Gy/6weeks. Patients were assessed for the response and tolerability.

Results

The overall response rate was 40% with no complete response obtained. At a median follow up of 18 months, the overall survival was 75% and median survival was 12 month.

Treatment toxicity was mainly hamotological in 75% of patients. No grades III or IV toxicity were registered. Nausea and vomiting Grade III was reported in 15 patients (75%), esophagitis grade I in 3 patients (15%), radiation pneumonitis grade I, II in 5 patients (25%), alopecia in 6 patients (30%), nephrotoxicity in 3 patients (15%).

Conclusion

Combination chemotherapy of cisplatin and gemcitabine is a tolerable and active induction chemotherapy regimen for patients with locally advanced NSCLC. Sequential radiotherapy given after induction chemotherapy is tolerable with potential improvement in both locoregional control and survival.

References

. Theodore, S.; Avraham, E. and Doona, S.: Gemcitabine-mediated radiosensitization. Seminars in Oncology, Vol. 24, No. 2. Suppl.; 7 (April), PP. S7-24-28, 1997.

. Guckenberger M, Klement RJ, Allgauer M, et al. Applicability of the linearquadratic formalism for modeling local tumor control probability in high dose per fraction stereotactic body radiotherapy for early stage non-small cell lung cancer. Radiother Oncol 2013;109:13-20.

. Osti MF, Agolli L, Valeriani M, et al. Image guided hypofractionated 3-dimensional radiation therapy in patients with inoperable advanced stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2013;85:e157-63.

. Kong FM, Ten Haken R, Hayman J, et al. Personalized High Dose Radiation (> 70 Gy) Is Significantly Associated with Better Local Regional Control and Overall Survival in Non-small Cell Lung Cancer Treated with Concurrent Chemoradiation. Int J Radiat Oncol Biol Phys 2011;81:S594.

. Phernambucq EC, Hartemink KJ, Smit EF, et al. Tumor cavitation in patients with stage III non-small-cell lung cancer undergoing concurrent chemoradiotherapy: incidence and outcomes. J Thorac Oncol 2012;7:1271-5

. Crino, L.; Giorgio, S. and Filippo, D.: Gemcitabine-Cisplatin chemotherapy followed by radiotherapy in locally advanced NSCLC: (A phase II retrospective analysis) M. Tonata. Forlanini Hosp., Rome, Italy; Univ. Hosp. Turin, Italy; Regina, Elena, Rome Italy, 2000

. Salama JK, Stinchcombe TE, Gu L, et al. Pulmonary toxicity in Stage III nonsmall cell lung cancer patients treated with high-dose (74 Gy) 3-dimensional conformal thoracic radiotherapy and concurrent chemotherapy following induction chemotherapy: a secondary analysis of Cancer and Leukemia Group B (CALGB) trial 30105. Int J Radiat Oncol Biol Phys 2011;81:e269-74.

. Curran WJ Jr, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst 2011;103:1452-60

. Pisters KMW, Vallieres E, Crowley JJ et al. Surgery with or without preoperative paclitaxel and carboplatin in early-stage non-small-cell lung cancer: Southwest Oncology Group Trial S9900, an intergroup, randomized, phase III trial. J Clin Oncol 2010; 28: 1843

. Bral S, Duchateau M, Versmessen H, et al. Toxicity report of a phase 1/2 dose-escalation study in patients with inoperable, locally advanced nonsmall cell lung cancer with helical tomotherapy and concurrent chemotherapy. Cancer 2010;116:241-50

. Cannon DM, Mehta MP, Adkison JB, et al. Dose-limiting toxicity after hypofractionated dose-escalated radiotherapy in non-small-cell lung cancer. J Clin Oncol 2013;31:4343-8

. Taremi M, Hope A, Dahele M, et al. Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients. Int J Radiat Oncol Biol Phys 2012;82:967-73.

. Crino, L.; Giorgio, S. and Filippo, D.: Gemcitabine-Cisplatin chemotherapy followed by radiotherapy in locally advanced NSCLC: (A phase II retrospective analysis) M. Tonata. Forlanini Hosp., Rome, Italy; Univ. Hosp. Turin, Italy; Regina, Elena, Rome Italy, 2000

. Crino, L.; Betti, M. and Gregorce: A phase III study of induction chemotherapy with gemcitabine and cisplatin in locally advanced stage III NSCLC. M. Tonata. Div. Medical Oncology, Regina Elena Institute, Rome, Italy, 1999

. Brett, S.; Celano, A. and Casadio, C.: A phase II study of gemcitabine and cisplatine combination regimen as induction chemotherapy in locally advanced NSCLC: Medical Oncology Department. And Radiotherapy Dept. Osp. Oncologico San Giovanni, A.S. and thoracic Surgery, University of Torino, Italy, 1998

. Saunders DB and Trapp GR,et al :Basic and clinical biostatistics, 5th edition, Connecticut, Appleton & Lang .2011.

. Aup

. Machtay M, Bae K, Movsas B, et al. Higher Biologically Effective Dose of Radiotherapy Is Associated with Improved Outcomes for Locally Advanced Non-Small Cell Lung Carcinoma Treated with Chemoradiation: An Analysis of the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 2012;82:425-34

. Sause, W.T.; Scoot, C.; Tayulor, S. et al.: Radiation Therapy Oncology Group (RTOG) 8808 and (ECOG) 45:88: Preliminary results of a phase III trial in regionally advanced, unresectable non-small cell lung cancer. J. Net. Cancer Inst. 87: 198-205, 1995

. Morton, R.; Jett, J.; McGinnis, W. et al.: Thoracic radiation therapy alone compared with combined chemoradiotherapy for locally advanced NSCLS. A randomized phase III trial. Ann. Int. Med.; 115:681-686, 1991.

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Published

2016-01-25

How to Cite

Abdou, E., Al-Shahhat, K., & Gaafar, M. (2016). Efficacy and Tolerability for Neoadjuvant Chemotherapy in Locally Advanced Non-Small Cell lung Cancer. International Journal of Sciences: Basic and Applied Research (IJSBAR), 25(2), 1–14. Retrieved from https://gssrr.org/index.php/JournalOfBasicAndApplied/article/view/5149

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Vol. 25 No. 2 (2016)

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