Preoperative concurrent chemoradiotherapy with cisplatin and docetaxel in patients with locally advanced non-small-cell lung cancer

Abstract

The objective of this study was to assess the feasibility and effectiveness of an induction chemoradiotherapy regimen followed by surgery in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). A total of 22 patients with LA-NSCLC were treated with induction chemoradiotherapy consisting of cisplatin (40 mg m À2 ) and docetaxel (40 mg m À2 ) given on days 1, 8, 29 and 36 plus concurrent thoracic irradiation at a dose of 40 -60 Gy (2 Gy fraction À1 day À1 ). Surgical resection was performed within 6 weeks after completion of induction therapy. Objective response to the induction therapy was obtained in 16 patients (73%). In all, 20 patients (91%) underwent surgery and complete resection was achieved in 19 patients (86%). Pathological downstaging and pathological complete response were obtained in 14 (64%) and five (23%) patients, respectively. With a median follow-up period of 32 months, the calculated 3-year overall and progression-free survival rates were 66 and 61%, respectively. It is noteworthy that the 3-year overall survival rate in 14 patients achieving pathological downstaging was extremely high (93%). Toxicity was manageable with standard approaches. No treatment-related deaths occurred. This combined modality treatment is feasible and highly effective in patients with LA-NSCLC. The results warrant further large-scale study to confirm the effectiveness of this regimen.

Concomitant chemoradiotherapy with cisplatin and docetaxel followed by surgery and consolidation chemotherapy in patients with unresectable locally advanced non-small cell lung cancer

“…Phase II trials using cisplatin 40 mg/m 2 and docetaxel 40 mg/m 2 with concurrent 40-60 Gy radiotherapy reported RR of 73-78.2% and median OS of 19.1-23.4 months. Major dose limiting toxicities were radiation esophagitis and neutropenia [4,8]. These results support the use of cisplatin and docetaxel combination with concomitant radiotherapy in locally advanced NSCLC.…”

“…Benefits of this approach include better local control, prevention of systemic dissemination, and downstaging of tumor in some cases enabling surgical resection. Preoperative use of concomitant chemoradiotherapy has been shown to effectively downstage these tumors to allow surgery with curative intent [5][6][7][8][9][10][11]. Therefore, trimodality treatment involving surgery after concomitant chemoradiation has drawn more attention recently [8][9][10][11].…”

Density of Tumor-Infiltrating FOXP3+ T Cells as a Response Marker for Induction Chemoradiotherapy and a Potential Prognostic Factor in Patients Treated with Trimodality Therapy for Locally Advanced Non-Small Cell Lung Cancer

“…For all patients, concurrent CRT with cisplatin-based doublet therapy was conducted according to the protocol reported by Katayama, et al 16) Regimens were modified based on toxicity during induction therapy. Responses to induction therapy were evaluated according to the RECIST guideline (version 1.1).…”

Induction chemoradiotherapy prior to surgery for non-small cell lung cancer invading the left atrium

“…According to recent reports, concurrent chemoradiotherapy is superior to chemotherapy for the control of local disease [6]. We have also reported the usefulness of induction chemoradiotherapy for locally advanced NSCLC, enabling pathological downstaging in 64% of patients and pathological CR in 23% [3]. In the present patient, induction chemoradiotherapy successfully controlled the local disease, enabling us to avoid performing a CPB during the en bloc resection of his tumor.…”

“…We judged that initial surgery would require cardiac arrest under cardiopulmonary bypass (CPB) for the complete resection of the extended tumor. Thus, he was treated with chemoradiotherapy in an induction setting: cisplatin and docetaxel with concurrent thoracic radiation at a dose of 40 Gy [3]. An objective response to the induction chemoradiotherapy was obtained, as shown in Fig.…”