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E. McCaffrey



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    P1.09 - Poster Session 1 - Combined Modality (ID 212)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P1.09-008 - Outcomes in a single institution series of patients with Stage III non-small cell lung carcinoma treated with curative-intent radiotherapy and concurrent carboplatin and paclitaxel chemotherapy. (ID 1150)

      09:30 - 09:30  |  Author(s): E. McCaffrey

      • Abstract

      Background
      The standard of care for patients with a good performance status and inoperable stage III non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (1–3). Carboplatin and paclitaxel is an alternative to the cisplatin-based doublets that have been used traditionally (4). Early-phase studies with small numbers have been reported (5–7) but a randomised phase 3 comparison has not been performed. The objective of this study was to assess outcomes in a large cohort of patients treated with curative-intent radiotherapy and concurrent carboplatin and paclitaxel chemotherapy.

      Methods
      Consecutive patients between March 2004 and May 2012 with stage III NSCLC undergoing curative-intent 3D-conformal radiotherapy to 60-66 Gy in 30-33 daily fractions with concurrent weekly carboplatin (45mg/m[2]) and paclitaxel (AUC=2) were identified from a prospective database. Consolidation chemotherapy was not given. Individual medical charts, radiology and laboratory investigations were reviewed retrospectively. Baseline clinico-pathologic, treatment, outcome and toxicity details were recorded. A minimum follow-up of three months after completion of treatment was required unless death occurred sooner. Median follow-up and survival times were calculated from date of first contact using the Kaplan-Meier method.

      Results
      One hundred and sixteen patients were identified and baseline characteristics are provided in Table 1. Nine patients were excluded as the chemotherapy regimen changed after at least one cycle and the remaining 107 patients were analysed. Median follow-up was 43.5 months. Imaging at three months post-treatment demonstrated a complete response in 4 (4%) patients and a partial response in 68 (64%) patients. Nine (8%) patients had already died. Median progression free survival and median survival were 15 and 22 months, respectively. Locoregional control was 53%. Failure at any site occurred in 75 (70%) patients. Isolated distant failure occurred in 24 (22%) patients with 9 in the brain. Adjustments to chemotherapy dose or number of planned cycles were required in 29 (27%) patients. Fifty two (49%) patients were admitted during treatment. Seven patients experienced an acute hypersensitivity reaction to paclitaxel. Grade 3/4 neutropenia, thrombocytopenia, nephrotoxicity, oesophagitis and pneumonitis were observed in 15%, 1%, 3%, 11% and 9% of patients, respectively. There was 1 episode of fatal radiation pneumonitis.

      Table 1. Patient characteristics. ECOG= Eastern Co-operative Group; FEV-1= forced expiratory volume in one second; PET= positron emission tomography; NOS = not otherwise specified.
      Total number of patients (%) 116 (100)
      Age, years
      Median 65
      Range 32-80
      Sex: number (%)
      Male 78 (67)
      Female 38 (33)
      Performance status: number (%)
      ECOG 0 45 (39)
      ECOG 1 62 (53)
      ECOG 2 7 (6)
      Unknown 2 (2)
      Smoker: number (%)
      Never 3 (3)
      Current or ex-smoker (≥10 pack-years) 111 (96)
      Unknown 2 (2)
      Smoking history, pack-years
      Mean 53.4
      Range 0-250
      FEV-1, litres
      Mean 2.05
      Range 0.62-4.25
      Loss of weight: number (%)
      None 98 (84)
      ≥10% 18 (16)
      Stage: number (%)
      IIIA 75 (65)
      IIIB 41 (35)
      PET-staged before treatment: number (%)
      Yes 113 (97)
      No 3 (3)
      Histology: number (%)
      Adenocarcioma 43 (37)
      Squamous cell carcinoma 45 (39)
      Carcinoma NOS 22 (19)
      Other 3 (3)
      Unknown 3 (3)

      Conclusion
      This review of a large, single institution series of patients with inoperable Stage III NSCLC treated with curative intent demonstrates that the concurrent administration of carboplatin and paclitaxel with radiotherapy is feasible. Survival and toxicity outcomes compare favourably to those reported with concurrent cisplatin and etoposide (4).