Multimodality treatment of stage III non-small cell lung cancer: Analysis of a phase II trial using preoperative cisplatin and gemcitabine with concurrent radiotherapy

Rolando M. D'Angelillo, Lucio Trodella, Marzia Ciresa, Francesco Cellini, Michele Fiore, Carlo Greco, Eugenio Pompeo, Tommaso Claudio Mineo, Laura Paleari, Pierluigi Granone, Sara Ramella, Alfredo Cesario

Research output: Contribution to journalArticle

Abstract

Introduction: We report the results of a phase II trial exploring the efficacy and the feasibility of combination of gemcitabine and cisplatin concurrent with radiotherapy followed by surgery in patients with stage III non-small cell lung cancer. Methods: Patients with histocytologically confirmed non-small cell lung cancer were treated with cisplatin 80 mg/sqm/wk of 1 and 4 or 20 mg/sqm/d of weeks 1 and 4 and weekly gemcitabine at 300 to 350 mg/m plus involved field radiotherapy. A 3D-conformal radiotherapy was delivered up to 50.4 Gy, with daily fractionation of 1.8 Gy. After clinical, radiologic, and pneumological reassessment, patients who reentered criteria for resectability were operated. Results: The stage at diagnosis was IIIA-N2 in 29 patients and IIIB-T4N0-2 for vascular direct infiltration for the remaining 21. Fifteen patients (30%) experienced acute grade 3 to 4 hemathological toxicity, whereas acute grade 3 esophageal toxicity was recorded in three patients (6%). One patient developed a grade 4 pulmonary toxicity (2%). Clinical response was 40 (80%) partial response, one (2%) stable disease, and nine (18%) progressive disease. Thirty-six patients (72%) underwent surgery. Final pathology showed a downstaging to stage 0 to I in 25 cases (50%). Median overall survival for all patients was 21.8 months, with a 3-year survival of 40.2%. CONCLUSIONS:: The results of this phase II trial confirm the feasibility and the efficacy of concurrent chemoradiotherapy followed by surgery.

Original languageEnglish
Pages (from-to)1517-1523
Number of pages7
JournalJournal of Thoracic Oncology
Volume4
Issue number12
DOIs
Publication statusPublished - Dec 2009

Keywords

  • Chemoradiotherapy
  • Gemcitabine
  • Locally advanced disease
  • Neoadjuvant therapy
  • Nodal clearance
  • Non-small cell lung cancer

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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    D'Angelillo, R. M., Trodella, L., Ciresa, M., Cellini, F., Fiore, M., Greco, C., Pompeo, E., Mineo, T. C., Paleari, L., Granone, P., Ramella, S., & Cesario, A. (2009). Multimodality treatment of stage III non-small cell lung cancer: Analysis of a phase II trial using preoperative cisplatin and gemcitabine with concurrent radiotherapy. Journal of Thoracic Oncology, 4(12), 1517-1523. https://doi.org/10.1097/JTO.0b013e3181b9e860