By Jenny Powers
LUGANO, Switzerland -- May 7, 2009 -- Patients identified as determined to be unable to tolerate chemoradiation can achieve a comparable survival rate when treated with radiation alone in patients with inoperable, locally advanced non-small-cell lung cancer (NSCLC), according to research presented here at the European Multidisciplinary Conference in Thoracic Oncology (EMCTO) 2009.
While induction chemotherapy prior to radical radiotherapy is indicated in the treatment of locally advanced, inoperable NSCLC, patients may present with significant comorbidities, decreased performance status, or advanced age that render them poor candidates to tolerate the toxicities associated with chemoradiation, explained Reena Davda, MD, North Middlesex Hospital, London, United Kingdom, speaking here on May 2. Cisplatin-based chemoradiation induces DNA damage that may undergo nucleotide excision repair mediated by the excision repair cross-complementation group 1 (ERCC1) enzyme.
Thus, tumour expression of ERCC1 may be associated with cisplatin resistance, poorer treatment response, and decreased survival rates.
In this study, 82 patients determined to be able to tolerate chemoradiation were given 2 cycles of carboplatin (area under the curve 5) on day 1, vinorelbine 25 mg/m2 on days 1 and 8 followed by computed tomography planned conformal radiotherapy of 55 Gy in 20 fractions and, as determined by their tolerance, 2 further chemotherapy cycles. The median age in this group was 67 years (range: 40 to 85 years).
Forty-five patients who were determined to be unable to tolerate chemoradiation, but still had an Eastern Cooperative Oncology Group Performance Status greater than 2, received a radiotherapy dose of 55 Gy in 20 fractions. The median age in this group was 74 years (range: 42 to 89 years).
The median survival in the chemoradiation group was 554 days (18.2 months), compared with median survival of 533 days (17.5 months) in the radiotherapy group. No significant difference was seen in survival between the 2 groups using a Chi-squared test analysis (P = .35).
The team concluded that patients with inoperable stages 2/3 NSCLC who are identified as unable to tolerate chemoradiation may be effectively treated with radiation alone and experience comparable overall survival.
The awaited results of the immunohistochemical analysis of samples taken at diagnosis should yield information regarding tumour expression of ERCC1 and response to cisplatin, which may be useful in determining treatment, the authors noted.
EMCTO 2009 was co-organised by the European Society for Medical Oncology (ESMO), the European Society for Therapeutic Radiology and Oncology (ESTRO), the European Society of Thoracic Surgeons (ESTS), and the European Respiratory Society (ERS).
[Presentation title: Sequential Chemoradiation and Radiation Alone in the Treatment of Inoperable, Locally Advanced Non-Small Cell Lung Cancer (NSCLC) and Sequential Chemoradiation and Radiation Alone in the Treatment of Inoperable, Locally Advanced Non-Small Cell Lung Cancer (NSCLC) and Correlation of Tumour ERCC1 With Survival. Abstract 105PD]
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