Paclitaxel Plus Carboplatin Concurrent With Three-dimensional Radiotherapy For Locally Advanced Non-small Cell Lung Cancer

Objects: To evaluate the efficacy and toxicity ofpaclitaxel plus carbo platincombined with three-dimensional conformal radiotherapy (3-DCRT) for locallyadvanced non-small cell lung cancer (NSCLC).Methods: From Jul 2002 to Jul 2004, 52 patients with locally advanced non-small cell lung cancer were treated with 3-DCRT in combination with paclitaxel andcarboplatin chemotherapy. 21 cases were received 3-DCRT and weekly paclitaxel andcarboplatin concurrent chemoradiotherapy (concurrent group).31 cases were receivedpaclitaxel and carboplatin sequential chemotherapy and 3-DCRT.(sequential group).In the concurrent group, paclitaxel was prescribed as 40mg/m~2 for 1 hour injection. Carboplatin was prescribed as 1.5 AUC/cycle after paclitaxel. The chemotherapy weregivenondl, d8, d15, d29, d36, d43. In the sequential group, chemotherapy were given 2cycles two weeks before radiotherapy. Paclitaxl 150mg/m~2 and carboplatin 5 AUC/cycle were given on dl and d28.3-DCRT was administered two weeks after the secondcycle chemotherapy when the Hematologic examination in normal. 3-DCRT was given as 1.8-2.0Gy/f, total dose 60-64 Gy/6-8w.Results: All the patients have finished the trial. The treatment time in 12 caseshas been prolonged for more than 1 week because of serious leucopenia.5 of them inconcurrent group and 7 in sequential group. The complete response rate (CR) was10％(2/21) and partial response (PR)rate was 71％(15/21) in concurrent group. Nochange and progress disease (NC+PD)was 19％(4/21). The overall response ratewas (CR+PR) 81％. The CR rate was 6％(2/31) and PR 68％(21/31)in sequentialgroup (CR), NC and PD was 26％(8/31). Total CR and PR was 74％in sequential group. 2—3 grade of esophagitis and pneumonia and leukocytopenia occurred in concurrent group and sequential group were 62％(13/21) and 42％(13/31), 24％(5/21) and 23％(7/31), 43％(9/21) and 19％(6/31). 1 patients in concurrent group wasⅣleukocytopenia. The median follow up duration was 22 (3～29) months. Mediansurvival time was 17.5 months(19.0 m for concurrent group, 15.8 m for sequential group). Overall 1, 2 and-year survival rate was72％, 37％respectively. 1 and 2-yearlocal control rate was 75％, 75％.Conclusions: Paclitaxel and carboplatin chemotherapy combined with3-DCRT achieved well response rate both in concurrent and sequential group forlocally advanced non-small cell lung cancer (NSCLC). There was no significantdifference between the two groups (P＞0.05). Esophagitis and pneumonia in the twogroups had no significant difference too (P＞0.05). 2—4 leukocytopenia inconcurrent group was more than sequential group (P=0.03) The toxicity ofchemotherapy and radiotherapy can be tolerated by the patients. Further randomizedstudy and follow-up were needed to prove the result.