Concurrent Paclitaxel-Cisplatin and Twice-a-DayIrradiation in Stage IIIA and IIIB NSCLC Shows Improvement in Local Control and Survival with Acceptable Hematologic Toxicity

Julianna PISCH1, Tibor MOSKOVITZ2, Olga ÉSIK3, Peter HOMEL4, Steven KELLER5

1Department of Radiation Oncology, Beth Israel Medical Center, New York, USA
2Department of Medical Oncology, Beth Israel Medical Center, New York, USA
3Department of Biostatistics, Beth Israel Medical Center, New York, USA
4Department of Oncotherapy, Semmelweis University, Budapest, Hungary
5Department of Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA


Non-small-cell lung cancer (NSCLC) has one of the highest death rates among the various forms of cancer. In attempts to improve on this unsatisfactory outcome, different radiation schedules and chemo-therapy agents have been examined in phase II or III studies. These have led to modest improvements in local control and survival, but combined therapies are associated with substantial hematologic toxicity. In this phase II study, 80 consecutive stage IIIA or IIIB NSCLC patients were treated with concomitant chemotherapy and twice-a-day irradiation in a total dose of 60 Gy in 1.5 Gy fractions. Patients scheduled for surgery received 45 Gy only. Paclitaxel (30 mg/m 2 ) on days 1-4 and cisplatin (100 mg/m 2 ) on day 5 were administered in the first and fourth weeks of treatment. Granulocyte colony stimulating factor (30 ng/m 2 ) was given on days 10-15. The local control, the 1- and 2-year survival rates and the occurrence of acute hematologic toxicity in the non-surgically treated patients were examined. Fifty-two patients were treated without and 28 with surgery. Among the non-surgically treated cases, 43 were evaluable for response and 47 for acute toxicity during a median follow-up of 22 months. The rate of local control was 65% (28/43), and the 1- and 2-year survival rates proved to be 68% and 48%, respectively, with a median survival of 28 months. Severe acute grade 3-4 toxicities included grade 4 leukopenia in 6 cases (13%), grade 3 leukopenia in 4 cases (9%), grade 3 esophagitis in 3 cases (6%) and grade 3 anemia in 3 cases (6%). Our results and the relevant data from the literature support the application of twice-a-day irradiation with concomitant chemotherapy in stage IIIA and IIIB NSCLC. Local control and survival were improved relative to once-a-day irradiation with sequential or concomitant chemotherapy. Pathology & Oncology Research, Vol 8, Nr 3, 163-169, 2002

Received: Jun 11, 2002; accepted: Jul 21, 2002
Correspondence: Julianna PISCH, Department of Radiation Oncology, Beth Israel Medical Center, First Avenue at 16 Street New York NY 10003, USA; Tel: 1-212-4202592, Fax: 1-212-4203314; E-mail:

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