THE PRELIMINARY RESULTS OF NEOADJUVANT CHEMOTHERAPY AND DEFINITIVE RADIOTHERAPY IN STAGE IIIB NON-SMALL CELL LUNG CARCINOMAS

Debate still exists over the treatment of locally advanced non-small cell lung carcinomas. With the aim of investigating the efficacy of neoadjuvant chemotherapy and definitive radiotherapy, a prospective trial was stated and preliminary results of this trial is presented in this article. Between January 1992 and December 1993, 25 patients who had Stage IIIB NSCLC were treated with 2 cycles of neoadjuvant chemotherapy (CDDP 100 mg/m2 on D1, ETOPOSIDE 100mg/m2 on D1,2,3; cycles repeated every 21 day) and definitive radiotherapy (hyperfractionated or conventional). Response to chemotherapy was defined as radiological regression. While 50.4 Gy was given to the mediastinum and 69.6 Gy was given to the primary tumor bed in the hyperfractionation regimen, 46 Gy and 66 Gy were given to the same regions respectively in the conventional arm. The response to 2 cycles of neoadjuvant chemotherapy was %40 (10/25). After chemotherapy 6 cases were irradiated with conventional fractionation while 14 cases were irradiated with hyperfractionation. Other than 5 patients who showed clinical and radiological progression during and after chemotherapy, all patients received planned radiotherapy. Oesophagitis was the most common toxicity observed (RTOG Grade III in 1 case and Grade II in 3 cases and Grade I in 16 cases). Also WHO Grade II emesis was observed in 2 cases and WHO Grade II hematological toxicity in 1 case. Median survival is 12 months. Six patients are now under follow-up, 2 of whom are symptom-free.