High-dose 3-dimensional conformal radiotherapy with concomitant vinorelbine plus carboplatin in patients with non-small cell lung cancer: A feasibility study

Lin,Qiang; Wang,Jun; Liu,Yue'e; Su,Huiling; Wang,Na; Huang,Yuehua; Liu,Chao-Xing; Zhang,Ping; Zhao,Yannan; Chen,Kun

doi:10.3892/ol.2011.317

High-dose 3-dimensional conformal radiotherapy with concomitant vinorelbine plus carboplatin in patients with non-small cell lung cancer: A feasibility study

Authors:
- Qiang Lin
- Jun Wang
- Yue'e Liu
- Huiling Su
- Na Wang
- Yuehua Huang
- Chao-Xing Liu
- Ping Zhang
- Yannan Zhao
- Kun Chen
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Affiliations: Department of Oncology, Hebei Medical University Affiliated North China Petroleum Bureau General Hospital, Hebei 062552, P.R. China, Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang 050011, P.R. China, Department of Radiation Oncology, Beijing University First Hospital, Beijing10034, P.R. China
Published online on: May 16, 2011 https://doi.org/10.3892/ol.2011.317
Pages: 669-674

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Abstract

The aim of this study was to evaluate the feasibility of high-dose 3-dimensional conformal radiotherapy (3DCRT) (70 Gy) with concomitant vinorelbine (NVB) plus carboplatin (CBP) chemotherapy in patients with non-small cell lung cancer (NSCLC). Patients with advanced NSCLC were treated with 3-dimensional conformal radiotherapy in conventional fractionation: 2 Gy/fraction, 1 fraction/day, 5 fractions/week; total dose 70 Gy. The radiotherapy planning of every case had met the following conditions: the percentage of total lung volume receiving 20 Gy (V20) ≤30% and the percentage of total lung volume receiving 30 Gy (V30) ≤20%. Chemotherapy was commenced on the first day of radiotherapy: NVB 25 mg/m2, day 1 and day 8, CBP at AUC of 5 mg/ml-1.min-1, day 8, repeated for 28 days, two concomitant cycles during radiotherapy, and not more than 4 cycles following radiotherapy. A total of 37 patients were recruited and each of them completed the entire radiation procedure. No Grade V toxicity was observed within the group. The hematological toxicity rates were: Grade III/IV neutropenia was observed in 18.9% (7/37) of cases, Grade III/IV thrombo-cytopenia in 8.1% (3/37) of cases, but no cases of Grade III/IV anemia were noted. For non-hematological toxicities the rates were: Grade III radiation pneumonitis, 8.1% (3/37) of cases; Grade III radiation esophagitis, 13.5% (5/37); but no cases of Grade IV/V non-hematological toxicities. High-dose 3DCRT also achieved a favorable efficacy: the complete response (CR) rate was 13.5% (5/37) and the partial response (PR) rate was 64.9% (24/37). The total response (CR+PR) rate was 78.4% (29/37). The median survival time was 12 months and the 1-year overall survival rate was 45.1%. Given that 35% of patients in the study had stage IV disease, the survival results were comparable with other similar studies. In conclusion, in our small-sample exploratory study, the high‑dose regimen of 70 Gy using 3DCRT with concomitant NVB plus CBP was feasible for patients with NSCLC. Further evaluation of this regimen is ongoing in a prospective controlled phase II trial.

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1	Parkin DM, Bray F, Ferlay J and Pisani P: Global cancer statistics, 2002. CA Cancer J Clin. 55:74–108. 2005. View Article : Google Scholar
2	Dillman RO, Herndon J, Seagren SL, Eaton WL Jr and Green MR: Improved survival in stage III non-small-cell lung cancer: seven year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst. 88:1210–1215. 1996.PubMed/NCBI
3	Furuse K, Fukuoka M, Kawahara M, Nishikawa H, Takada Y, Kudoh S, Katagami N and Ariyoshi Y: Phase III study of concomitant versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small cell lung cancer. J Clin Oncol. 17:2692–2699. 1999.PubMed/NCBI
4	Liang HY, Zhou H, Li XL, Yin ZH, Guan P and Zhou BS: Chemo-radiotherapy for advanced non-small cell lung cancer: concomitant or sequential? It's no longer the question: a systematic review. Int J Cancer. 127:718–728. 2010. View Article : Google Scholar
5	Perez CA, Pajak TF, Rubin P, Simpson JR, Mohiuddin M, Brady LW, Perez-Tamayo R and Rotman M: Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy. Report by the Radiation Therapy Oncology Group. Cancer. 59:1874–1881. 1987. View Article : Google Scholar : PubMed/NCBI
6	Bradley J: A review of radiation dose escalation trials for non-small cell lung cancer within the Radiation Therapy Oncology Group. Semin Oncol. 32:S111–S113. 2005. View Article : Google Scholar : PubMed/NCBI
7	Bradley JD, Moughan J, Graham MV, Byhardt R, Govindan R, Fowler J, Purdy JA, Michalski JM, Gore E and Choy H: A phase I/II radiation dose escalation study with concomitant chemotherapy for patients with inoperable stages I to III non-small-cell lung cancer: phase I results of RTOG 0117. Int J Radiat Oncol Biol Phys. 77:367–372. 2010. View Article : Google Scholar : PubMed/NCBI
8	Graham MV, Purdy JA, Emami B, Harms W, Bosch W, Lockett MA and Perez CA: Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 45:323–329. 1999.PubMed/NCBI
9	Wang S, Liao Z, Wei X, Liu HH, Tucker SL, Hu CS, Mohan R, Cox JD and Komaki R: Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concomitant chemotherapy and three-dimensional conformal radiotherapy (3D-CRT). Int J Radiat Oncol Biol Phys. 66:1399–1407. 2006. View Article : Google Scholar
10	Yang LQ, Wu LP, Chen LJ, Zhang RN, Gao YQ, Chen GY and Liang NQ: Value of V20 and V30 parametres for predicting acute radiation lung toxicity after 3D radiotherapy for lung cancer. Chin J Cancer Prev Treat (In Chinese). 15:280–282. 2008.
11	Zhu GY, Xia TY, Wang LH, Gao XS, Wang JJ, Li AF, Zhang FQ, Ma L, Li YX and Xu B: Consensus and controversies on delineation of radiotherapy target volume for patients with non-small cell lung cancer. Chin J Radiat Oncol (In Chinese). 17:432–436. 2008.
12	Trotti A, Byhardt R, Stetz J, Gwede C, Corn B, Fu K, Gunderson L, McCormick B, Morrisintegral M, Rich T, Shipley W and Curran W: Common toxicity criteria: version 2.0. An improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys. 47:13–47. 2000. View Article : Google Scholar : PubMed/NCBI
13	Sun Y and Zhou J: Medical Oncology [M] (4th edition). People's Medical Publishing House (In Chinese). Beijing: 106–107. 2004.
14	El-Sharouni SY, Kal HB, Battermann JJ and Schramel FM: Sequential versus concomitant chemo-radiotherapy in inoperable stage III non-small cell lung cancer. Anticancer Res. 26:495–505. 2006.PubMed/NCBI
15	Sause W, Kolesar P, Taylor S IV, Johnson D, Livingston R, Komaki R, Emami B, Curran W Jr, Byhardt R, Dar AR and Turrisi A III: Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest. 117:358–364. 2000. View Article : Google Scholar
16	Schaake-Koning C, van den Bogaert W, Dalesio O, Festen J, Hoogenhout J, van Houtte P, Kirkpatrick A, Koolen M, Maat B and Nijs A: Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer. N Engl J Med. 326:524–530. 1992. View Article : Google Scholar : PubMed/NCBI
17	Fletcher GH: Clinical dose response curves of human malignant epithelial tumors. Br J Radiol. 46:1511973. View Article : Google Scholar : PubMed/NCBI
18	Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, Niibe Y, Karasawa K, Hayakawa K, Takai Y, Kimura T, Takeda A, Ouchi A, Hareyama M, Kokubo M, Hara R, Itami J, Yamada K and Araki T: Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol. 2:S94–S100. 2007. View Article : Google Scholar
19	Lichter AS and Lawrence TS: Recent advances in radiation oncology. N Engl J Med. 332:371–379. 1995. View Article : Google Scholar
20	Lin Q, Gao XS, Qiao XY, Zhou ZG, Zhang P and Yang XR: Dose escalation of cisplatin with 5-fluororacil in concomitant chemoradiotherapy for esophageal carcinoma. Chin J Radiat Oncol (In Chinese). 15:301–304. 2006.
21	Lin Q, Gao XS, Qiao XY, Zhou ZG, Zhang P, Chen K, Zhao YN and Asaumi J: Phase I trial of escalating-dose cisplatin with 5-fluorouracil and concomitant radiotherapy in Chinese patients with esophageal cancer. Acta Med Okayama. 62:37–44. 2008.PubMed/NCBI
22	Vokes EE, Herndon JE II, Crawford J, Leopold KA, Perry MC, Miller AA and Green MR: Randomized phase II study of cisplatin with gemcitabine or paclitaxel or vinorelbine as induction chemotherapy followed by concomitant radiochemotherapy for stage IIIB non-small-cell lung cancer: cancer and leukemia group B study 9431. J Clin Oncol. 20:4191–4198. 2002. View Article : Google Scholar
23	Zhang ZM, Zhao HY, Zhang CJ and Mu JG: Vinorelbine and carboplatin with concomitant radiotherapy in locally advanced non-small cell lung cancer. Chin J Clin Oncol (In Chinese). 9:625–627. 2004.
24	Rao CY: Study of concomitant versus sequential radiochemotherapy with vinorelbine and cisplatin in stage III non-small cell lung cancer. Chin J Cancer Prev Treat (In Chinese). 14:942–943. 2007.
25	Liu J, Lv CX, Wang JM, Li HX, Guo JD, Wang CL, Gao LT and Zhao L: Analysis of two different concomitant radiochemotherapy regimens in the treatment of locally advanced stage III non-small cell lung cancer. Chin J Clin Oncol (In Chinese). 15:226–229. 2010.
26	Wang JP, Zhai XM, Zhang JN and Xu CS: Clinical study on concomitant radiotherapy in combination with vinorelbine and cisplatin for advance non-small cell lung cancer. Acta Med Jiangsu Univ (In Chinese). 16:483–485. 2005.
27	Lu DJ, Wang L, Han C, Gao C and Li XN: Toxicity analysis for esophagus in locally advanced non-small cell lung cancer treatment using three dimensional conformal radiotherapy combined with concomitant chemotherapy. Chin J Radiol Med Prot (In Chinese). 30:185–188. 2010.
28	Zheng JX, Niu DL and Xu K: Radiotherapy combined with concomitant chemotherapy for stage III non-small cell lung cancer. Chin J Cancer Prev Treat (In Chinese). 13:1822–1823. 2006.