Uneven fractionation radiotherapy combined with cisplatin for lung cancer

One of the main causes of difficulty in radiotherapy on non-small cell lung cancer is local recurrence. In order to overcome local recurrences and to obtain higher local control rate, we tried to treat them with combined therapy of uneven fractionation radiotherapy and Cisplatin. Uneven fractionation regime is expected to bring about reoxygenation effectively compared to conventional radiotherapy, and Cisplatin was proved to be a hypoxic cell sensitizer by Douple et al. Therefore, combined therapy of these modalities is thought to be a reasonable method to achieve higher control rate of tumors. Thirty-four patients of lung cancer were treated with uneven fractionation regime combined with Cisplatin. In uneven fractionation radiotherapy, patients were given 5 Gy on Monday and 1.0 Gy or 1.2 Gy as daily dose from Tuesday through Friday in a week and the treatment was repeated 6 or 7 weeks in most of patients. Cisplatin of 40 or 50 mg/body was drip-infused intravenously just before the irradiation of 5 Gy, and repeated every week. The classification in cancer stage of 34 patients was 5 patients at stage I, 3 at stage II, 11 at stage III and 15 at stage IV. Histologically, 33 cases were non-small cell carcinoma, and 1 case was intermediated cell type of small cell carcinoma. As the results of treatment, 7 patients (21 %) showed complete response and 24 patients (71 %) had partial response. The survival rates of 24 months were calculated by Kaplan-Meier's method as 80 %, 67 %, 18 %, 16 % and 31 % for stage I, II, III, IV and all cases, respectively. Severe lung fibrosis was found in 5 out of 20 patients who lived for more than 6 months after the beginning of the treatment. (author)