Neoadjuvant chemotherapy in locally advanced non-small cell lung cancer

The objective of this study was to evaluate the role of neoadjuvant chemotherapy in the treatment of locally advanced non small cell lung cancer (NSCLC) followed by radiotherapy versus radiotherapy alone.

Sixty nine patients were randomized to chemotherapy (group A) or radiotherapy alone (group B). The induction chemotherapy consists of cisplatin (80 mg/m2) day 1 and Gemcitabine (1250 mg/m2), infusion day 1 and 8. Cycles were repeated every 3 weeks. Radiotherapy was given 4-6 weeks after chemotherapy to a dose of 60 Gy/30 fractions/6 weeks.

A total of 66 patients were evaluable for response; 34 in group A and 32 in group B. The overall response rate was 41.2% for group A and 21.8% for group B (P < 0.5) but with no complete response observed in either group. At a median follow up of 15 months, the overall survival was 65% and median survival was 12 months for group A. However in group B the overall survival at 15 months was 30% and the median survival was 9 nt (P < 0.001). Treatment toxicity in group A was mainly haemotological in 79% of patients none of them was grade II or IV. Grade Nausea and vomiting was reported in 73.5% of patients, grade I esophagitis in 5.8% of patients, grade I, radiation pneumonitis in 26.4% of patients. Alopecia was observed in 29.4% of patients, nephrotoxicity in 17.4%. Treatment toxicity in group B were generally less than in group A but not statistically significant except fr grade III vomiting (15.6%) and alopecia (0%).

Combination chemotherapy of cisplatin and gemcitabine is a tolerable and active induction chemotherapy regimen for patients with locally advanced NSCLC. Sequential radiotherapy given after induction chemotherapy is tolerable and offers a hope of improved locoregional control and survival compared with radiotherapy alone.