Concurrent paclitaxel or/and carboplatin with radiotherapy for stage III non-small cell lung cancer

Objective: To study the toxicity and efficacy of concurrent paclitaxel or/and carboplatin with radiotherapy for stage III non-small cell lung cancer (NSCLC). Methods: Forty-one patients pathologically diagnosed as suffering from NSCLC (III a: 17, III b: 24 ) received concurrent 60-70 Gy conventional fractionated external beam radiotherapy with chemotherapy: paclitaxel(45 mg/m2, n=13); or combined with carboplatin(AUC = 2, n=28), once weekly. Results: Thirty-seven patients received a total dose of 60-72 Gy, two received 54 Gy and two received 56 Gy. Thirty-eight patients received 4-6 weeks of chemotherapy, while three patients received only 2 weeks of chemotherapy. Two patients experienced grade 3 and 4 neutropenia, 4 grade 3 radiation esophagitis, 6≥ grade 2 radiation pneumonitis and one grade 3 mucositis. The total response rate( CR + PR) was 78%, with a median follow-up time of 17.2 months. The median survival time was 16.5 months(20.0 m for stage III a,15.8 m for III b, ).The overall 1-, 2- and 3-year survival rate was 69% ,34% and 34%, respectively. The median time of recurrence-free survival was 57.8 months. The 1- and 2-year recurrence-free survival(RFS) rate was 85% and 85%, respectively. The patterns of failure were 4 intra-field recurrence, 1 local and extra-field regional recurrence, 1 extra-field regional recurrence, 2 carcinomatous pleural effusion and 12 distant metastasis. Conclusions: Concurrent chemoradiotherapy with paclitaxel and/or carboplatin can well be tolerated, with a relatively good short and remote effectiveness. The major pattern of failure is distant metastasis. High radiation dose ( < 66 Gy) may provide a more satisfactory powerful effectiveness. (authors)