Induction therapy of loco-regional non-small-cell lung cancer with reliable response and low toxicity (low dose radiotherapy sensitizes tumor to subsequent chemotherapy?)

Introduction: For the induction therapy of non-small-cell lung cancer, we need to look for a regimen which produces a reliable high response rate with a low treatment related morbidity and mortality. Methods: Patients in clinical stages IB, IIA and B, IIIA and B received a course of therapy with 20 Gy of radiation in 2 weeks. This was followed by two courses of chemotherapy consisting of paclitaxel 180 mg/m², cisplatin 45 mg/m², and ifosfamide 1000 mg/m². Two to 3 weeks after chemotherapy, the patients were re-evaluated and, if suitable, underwent surgical therapy. Results: A total of 35 patients were entered into the study. The overall response rate was 82.86% (95% confidence interval, 66.35-94.5%). Complete response (CR) was 20% (95% confidence interval, 8.44-36.94%). Twenty-five patients had surgical resection. Subsequently 18 patients received completion radiotherapy of additional 45 Gy. The median follow up is 30 months. In 12 patients with stages IB, IIA and B, the median survival was 61 months, and 5-year survival was 55%. In 23 patients with stages IIIA and B, the median survival was 26 months, and 5-year survival was 9.5%. There was 1 patient with Grade 4 and 13 patients with Grade 3 leukopenia, and half of them received granulocyte colony stimulating factor. By the completion radiotherapy, 6 out of 18 patients had less than Grade 2 esophagitis. Five patients had Grade 2 radiation pneumonitis and one Grade 5 (one mortality). There was no postoperative death. The survival results were comparable to those reported recently by others, however the regimen produced a high response rate with low treatment related morbidity/mortality. Conclusion: It is a suitable regimen for induction therapy to include earlier stage resectable non-small-cell lung cancers.