Combined chemoradiation for locally advanced nonsmall cell lung cancer

We report the results of a phase I study investigating the feasibility of concomitant daily doses of Carboplatin (20 to 25 mg/m2/d over 45 or 10 minutes) and accelerated chest irradiation (60 to 64 Gy over 4 weeks, 2 Gy per fraction, using the concomitant boost technique), alone or following three cycles of induction chemotherapy (cisplatin: 25 mg/m2 per day, d1 to d5, 5-Fluorouracil (5-Fu): 600 mg/m2 per day, d1 to d5, and Vinorelbine: 25 mg/m2 per day, d1 and d5, at 4-week intervals) in 15 patients with locally advanced unresectable nonsmall cell lung cancer. All patients received the planned sequence. The dose-limiting toxicity was esophagitis (5/15 WHO grade 4). No toxic deaths were observed. The tumor response rate was high: 6/15 complete responses and 8/15 greater than 50% tumor regressions. The median survival has not been reached after a mean follow-up of 14 months (range: 6, 28). We are now planning a multicenter phase II study, using the following doses: 20 mg/m2 of daily Carboplatin over 10 minutes and 60 Gy of radiotherapy over 4 weeks.