Analysis of a Novel Protocol of Combined Induction Chemotherapy and Concurrent Chemoradiation in Unresected Non–Small-cell Lung Cancer: A Ten-year Experience with Vinblastine, Cisplatin, and Radiation Therapy

Eugenie Waters; Brian Dingle; George Rodrigues; Mark Vincent; Robert Ash; Rashid Dar; Richard Inculet; Walter Kocha; Richard Malthaner; Michael Sanatani; Larry Stitt; Brian Yaremko; Jawaid Younus; Edward Yu

Disclosures

Clin Lung Cancer. 2010;11(4):243-250. 

In This Article

Conclusion

This retrospective analysis of a large cohort of selected IIIA/IIIB NSCLC patients treated with VCRT at the LRCP is significant in several respects. The MST of 18 months and the 5-year OS of 20% is keeping with the literature for concurrent chemoradiation for the treatment of unresectable NSCLC.

There was no significant difference in survival between stage IIIA and IIIB NSCLC, or between those patients who did and did not encounter grade 4 toxicity over the course of VCRT. The unique VCRT protocol, which distributes each cycle of chemotherapy over 3 consecutive days, does not adversely affect survival. The success of VCRT appears dependent on both radiation and chemotherapy. Lastly, a small subset of VCRT patients who underwent completion surgery demonstrates that a pathologic complete remission is possible for patients with IIIA or IIIB NSCLC receiving combined concurrent chemoradiotherapy.

VCRT continues to be the treatment protocol of choice at the LRCP for that selected subset of stage IIIA/IIIB NSCLC for whom resection is not possible, who do not have a significant pleural effusion, and who have a distribution of tumor which can be captured in a safe radiation treatment plan. In its clinical application we are flexible with the timing of the radiation, which can be moved to the first or second cycle depending on the clinical presentation, resource availability, and on the ability to prepare safe treatment plans. Alternatively, the radiation may be delayed until tumor shrinkage is achieved, or in patients with borderline performance status where reverting to sequential therapy is occasionally judged preferable.

We are currently conducting a phase I/II trial of concurrent radiation with cisplatinum and weekly docetaxel, hoping to be able to compare this to VCRT.

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