jlc Journal of Lung Cancer J Lung Cancer 1598-7809 Korean Association for the Study of Lung Cancer 10.6058/jlc.2009.8.1.8 jlc-8-8 Original Article Concurrent Chemoradiotherapy with Weekly Paclitaxel for Locally Advanced Non-small Cell Lung Cancer JeongSeong HyunM.D. 1 JungJae HoM.D. 1 LeeHyun WooM.D. 1 KangSeok YunM.D. 1 4 ChoiYong WonM.D. 1 AhnMi SunM.D. 1 HwangYun HoM.D. 1 OhYoung TaekM.D., Ph.D. 2 4 ChoiJin-HyukM.D., Ph.D. 1 4 SheenSeung SooM.D. 3 4 ParkKwang JooM.D., Ph.D. 3 4 Departments of Hematology-Oncology Radiation Oncology Pulmonary and Critical Care Medicine Lung Cancer Center, Ajou University School of Medicine, Suwon, Korea Address for correspondence Jin-Hyuk Choi, M.D. Department of Hematology-Oncology, Ajou University School of Medicine, 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, Korea Tel: 82-31-219-4920 Fax: 82-31-219-5983 E-mail: jhchoimd@ajou.ac.kr 01 2009 10 01 2009 8 1 8 12 26122009 02022009 Copyright © 2009 Korean Association for the Study of Lung Cancer 2009 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). Paclitaxel is an active agent against NSCLC and it has a radiosensitizing effect. We investigated the efficacy and toxicity of weekly paclitaxel administration along with concurrent radiotherapy for treating locally advanced and locally recurrent NSCLC.

 Materials and Methods

Twenty-five previously untreated stage III or locally recurrent NSCLC patients received weekly paclitaxel (60 mg/m2) and concurrent radiotherapy. Chemotherapy was given on days 1, 8, 15 and 22. Concurrent radiotherapy at 1.5 Gy was given twice a day to a total dose of 54 Gy in 3.5 weeks. After the completion of CCRT, consolidation chemotherapy was delivered if possible.

 Results

The overall response rate was 72% with one complete response and 17 partial responses. The median overall survival was 16 months with a 2 year survival rate and a 5 year survival rate of 38% and 24%, respectively. The rate of grade ≥3 radiation pneumonitis was 16% (4 patients) and 2 patients were died from the pneumonitis. The rate of grade 3 radiation esophagitis was 12% (3 patients) and the hematologic toxicities were not significant.

 Conclusion

Weekly paclitaxel with concurrent radiotherapy is effective for treating locally advanced and locally recurrent NSCLC, but radiation pneumonitis is the major toxicity and this is potentially fatal.

 Non-small cell lung carcinoma Concurrent chemoradiotherapy Paclitaxel References Bae JM Won YJ Jung KW Survival of Korean cancer patients diagnosed in 1995 Cancer Res Treat 200234 319325 Spira A Ettinger DS Multidisciplinary management of lung cancer N Engl J Med 2004350 379392 Bae KW Song TH Yang JY Concurrent chemoradiation with weekly paclitaxel in locally advanced nonsmall cell lung cancer Tuberc Respir Dis 200457 351357 Cox JD Pajak TF Herskovic A Five-year survival after hyperfractionated radiation therapy for nonsmall-cell carcinoma of the lung (NSCLC): results of RTOG protocol 81–08 Am J Clin Oncol 199114 280284 Dillman RO Herndon J Seagren SL Eaton WL Jr Green MR Improved survival in stage III nonsmall-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial J Natl Cancer Inst 199688 12101215 Schaake-Koning C van den Bogaert W Dalesio O Effects of concomitant cisplatin and radiotherapy in inoperable nonsmall-cell lung cancer N Engl J Med 1992326 524530 Pritchard RS Anthony SP Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, nonsmall-cell lung cancer: a meta-analysis Ann Intern Med 1996125 723729 Furuse K Fukuoka M Kawahara M Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III nonsmall-cell lung cancer J Clin Oncol 199917 26922699 Curran W Jr Scott C Langer C Phase III comparison of sequential vs. concurrent chemoradiation for patients with unresected stage III nonsmall cell lung cancer (NSCLC): initial report of Radiation Therapy Oncology Group (RTOG) 9410 Proc Am Soc Clin Oncol 200019 A1891 Fournel P Robinet G Thomas P Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced nonsmall-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Franç ais de Pneumo-Cancé rologie NPC 95–01 Study J Clin Oncol 200523 59105917 Caffo O Radiosensitization with chemotherapeutic agents Lung Cancer 200134 Suppl 4 S81S90 Yano T Hara N Ichinose Y Local recurrence after complete resection for nonsmall-cell carcinoma of the lung: significance of local control by radiation treatment J Thorac Cardiovasc Surg 1994107 812 Shaw EG Brindle JS Creagan ET Foote RL Trastek VF Buskirk SJ Locally recurrent nonsmall-cell lung cancer after complete surgical resection Mayo Clin Proc 199267 11291133 Harpole DH Jr Herndon JE 2nd Young WG Jr Wolfe WG Sabiston DC Jr Stage I nonsmall cell lung cancer: a multivariate analysis of treatment methods and patterns of recurrence Cancer 199576 787796 Rowinsky EK Donehower RC Paclitaxel (taxol) N Engl J Med 1995332 10041014 Tishler RB Schiff PB Geard CR Hall EJ Taxol: a novel radiation sensitizer Int J Radiat Oncol Biol Phys 199222 613617 Milas L Hunter NR Mason KA Kurdoglu B Peters LJ Enhancement of tumor radioresponse of a murine mammary carcinoma by paclitaxel Cancer Res 199454 35063510 Milas L Hunter NR Mason KA Milross CG Saito Y Peters LJ Role of reoxygenation in induction of enhancement of tumor radioresponse by paclitaxel Cancer Res 199555 35643568 Milross CG Mason KA Hunter NR Chung WK Peters LJ Milas L Relationship of mitotic arrest and apoptosis to antitumor effect of paclitaxel J Natl Cancer Inst 199688 13081314 Kaplan EL Meier P Non-parametric estimations from incomplete observations J Am Stat Assoc 195853 457481 Choy H Safran H Akerley W Graziano SL Bogart JA Cole BF Phase II trial of weekly paclitaxel and concurrent radiation therapy for locally advanced nonsmall cell lung cancer Clin Cancer Res 19984 19311936 Kirkbride P Gelmon K Eisenhauer E Paclitaxel and concurrent radiotherapy in locally advanced nonsmall cell lung cancer: the Canadian experience Semin Radiat Oncol 19999 2 Suppl 1 102107 Bae SH Kim KC Lee SA Efficacy of weekly paclitaxel and concurrent radiation therapy for locally advanced nonsmall cell lung cancer Korean J Med 200569 379386 Kim S Kim SW Shim BY Treatment outcome of locally advanced nonsmall cell lung cancer patients who received concurrent chemoradiotherapy with weekly paclitaxel J Korean Soc Ther Radiol Oncol 200624 230236 Figures and Tables Figures and Tables

Overall survival and progression-free survival.

(A) Overall survival of locally advanced and locally recurrent NSCLC patients. (B) Progression-free survival of locally advanced and locally recurrent NSCLC patients. NSCLC: non-small cell lung cancer.

Patient Characteristics

Characteristic No. of patients (%)
Age (median) 62
Gender  
 Male 20 (80)
 Female 5 (20)
Histologic type  
 Squamous 11 (44)
 Adeno 7 (28)
 Others 7 (28)
Performance (ECOG)  
 0 1 (4)
 1 23 (92)
 2 1 (4)
Weight loss (≥5% in 6 months)  
 Yes 6 (24)
 No 19 (76)
Stage  
 IIIA 3 (12)
 IIIB 14 (56)
 Locally recurrent 8 (32)
Consolidation chemotherapy  
 Yes 6 (24)
 No 19 (76)

Response of Treatment

Response No. (%)
Overall response 18 (72)
 Complete response 1 (4)
 Partial response 17 (68)
 Stable disease 2 (8)
 Progressive disease 5 (20)

Toxicities

Toxicity Total (%) Grade 3/4 (%)
Hematologic    
 Neutropenia 12 (48) 1 (4)
 Anemia 7 (28) 0 (0)
 Thrombocytopenia 2 (8) 1 (4)
Non-hematologic      
 Esophagitis 11 (44) 3 (12)
 Pneumonitis 14 (56) 4 (16)
 Nausea 3 (12) 1 (4)
 Diarrhea 1 (4) 1 (4)