Author of

• 12573

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  P3.09 - Poster Session 3 - Combined Modality (ID 214)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Combined Modality
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12584

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    P3.09-011 - Concurrent chemoradiation for locally advanced Non Small Cell<br /> Lung cancer (NSCLC) using weekly Cisplatin and Docetaxel:<br /> retrospective analysis of toxicity and survival data . (ID 1875)

    09:30 - 09:30  |  Author(s): Y. Cox
    • Abstract

    Background
    Concurrent chemoradiation is the standard of care for majority of medically fit patients with locally advanced (IIIA and IIIB) NSCLC. Whilst the optimal radiation dose and schedule is well established (66Gy in 30#) the optimal chemotherapy regimen is less certain due to a paucity of phase III chemotherapy trials in this context. Phase II studies have demonstrated high disease response rates with acceptable toxicities when weekly cisplatin and docetaxel were administered concurrently with radiotherapy.SWOG chemoradiotherapy regimen with cisplatin and etoposide which is commonly used has not been compared to modern cisplatin doublet in phase III setting. Furthermore, in our experience the SWOG regimen is associated with significant toxicity. In 2004 we adopted a local chemoradiation protocol using weekly low dose cisplatin and docetaxel.

    Methods
    We searched oncology pharmacy dispensing records to identify community based patients treated with weekly cisplatin (20mg/m[2]) and docetaxel (20mg/m[2]) doublet regimen between 2004 and 2011. This data was cross referenced with radiation oncology database to identify a cohort of patients with locally advanced NSCLC who received concurrent radical radiation.Disease stage was recorded as documented in medical records. Toxicity data was collected and graded according to the NCI criteria. Progression free survival(PFS) was calculated from commencement of treatment until radiologically confirmed recurrence.Overall survival(OS) was calculated from commencement of treatment until death from any cause.

    Results
    Sixty eligible patients were identified. Median age was 63 yrs. 75% patients were male. Predominant histologies were squamous (43%) and adenocarcinoma (35%).The majority of patients were current or ex smokers (57% and 37% respectively) and were ECOG 1 at start of treatment (72%). 58% patients had stage IIIA disease and 40% stage IIIB. In addition to concurrent chemoradiation, 42% received either induction or consolidation chemotherapy. Grade 3/4 non haematological toxicities included oesophagitis (36%) and pneumonitis (1 patient).Significant haematological toxicities were rare with grade 3/4 anaemia,neutropenia and thrombocytopenia seen in 1, 2 and 1 patient respectively.Grade 3 /4 esophagitis seen in 36% cases. Treatment compliance was good with 73% of patients completing planned 6 weeks of chemotherapy. Chemotherapy delay due to toxicity occurred in 20 % patients.At least one hospital admission was seen in 36% patients. One treatment related death occurred. Median PFS was 10 months. Median OS was 20 months. In patients who relapsed ,chest was the most common site (n=15) followed by brain (n=13). As on February 2013,17 patients remain alive whilst an additional 8 patients have been lost on followup.

    Conclusion
    Low dose cisplatin and docetaxel when given concurrently with definitive radiotherapy for locally advanced NSCLC is a feasible regimen with negligible haematological toxicity. The incidence of esophagitis whilst relatively high is main non haematological toxicity seen and is comparable to that of other published data using this chemoradiation regimen. Furthermore this toxicity had minimal impact on treatment compliance and was without longterm sequelae. We believe our regimen is an acceptable alternative to the SWOG regimen.