Concurrent chemoradiotherapy with low dose weekly gemcitabine in stage III non-small cell lung cancer [NSCLC]

Background: combined chemoradiotherapy [CRT] is the treatment of choice for unresectable stage III NSCLC. Gemcitabine [G] is a novel deoxycitidine analogue that has been proven to be a potent radiosensitizer

Purpose: to demonstrate the efficacy, toxicity and tolerability of low dose Gemcitabine given weekly as radiosensitizer in stage III NSCLC

Patients and Methods: twenty-five patients with unresectable NSCLC were evaluable with a median age of 54 years [range 44-69]. Ten patients [40%] had stage IIIa and 15 patients [60%] had stage IIIb. Treatment consisted of gemcitabine 75 mg/m[2] day 1 of every week of irradiation [6 courses]. Thoracic irradiation was delivered in daily doses of 2Gy to a total dose of 60Gy over 6 weeks

Results: the overall response rate was 56% with complete response [CR] in 5 patients [20%], partial response [PR] in 9 patients [36%], stable disease [SD] in 5 patients [20%] and 6 patients showed progressive disease [PD] [24%]. The median overall survival was 15 months [95% CI: 11.2-20.6] and 1 year and 2 year survival rates were 58% and 37% respectively. The most frequent hematologic toxicity was neutropenia [40%] while radiation pneumonitis [32%] was the most frequently observed non-hematologic toxicity followed by esophagitis [24%], nausea and vomiting [20%]. One and two year progression-free survival rates were 55% and 28% respectively with median progression free survival 9 months [95% CI: 2.5-17.3]

Conclusion: gemcitabine might be used as rediosensitizer for patients with unresectable stage III NSCLC with feasible, tolerable side effects and considerable response rate. However, further randomized studies are needed to identify the optimal chemoradiotherapy regimens and schedules for treatment of unresectable NSCLC stage III

Paclitaxel as induction chemotherapy plus radiation for locally advanced sequamous cell carcinoma of the head and neck

The primary objective of this study was to asses the complete response [CR] rate to a new innovative induction regimen plus combined chemoradiation in patients with locally advanced head and neck cancer [LA-HNC]. From April 2003 to March 2005, 66 eligible patients with LA-HNC referred mainly from Oncosurgery Department to Clinical Oncology and Nuclear Medicine Department, Mansoura University Hospital were treated by three cycles of induction chemotherapy [IC] with paclitaxel 175mg/m[2] in 3-h infusion on d1, leucovorin [LV] 200mg/m[2] over 20min immediately followed by fluorouracil [FU] 400mg/m[2] bolus and then 600mg/m[2] as 24h continuous infusion on d1 and 2, cisplatin 75mg/m[2] over 1-h infusion on d2 every 3 weeks. This was followed by radiation [70Gy] am weekly cisplatin 20mg/m[2]. After the completion of IC, 12/66 [18.2%] patient had CR. The CR rate was increased to [53.03%] post concomitant chemoradiotherapy [CCRT]. Hematologic toxicity, alopecia and mucositis were the most common complications of treatment. Median time to progression was 10 months and median survival was 18 months. This novel induction regimen is active, well tolerated and can be successfully followed by CCRT with weekly cisplatin. CCRT should remain standard treatment for patients with LA-HNC