Concurrent chemoradiotherapy with bronchial arterial infusion of CDDP for the treatment of locally-advanced non-small cell lung cancer

The standard treatment for locally advanced (stage III) non-small cell lung cancer (NSCLC) is concurrent use of chemoradiotherapy containing cisplatinum (CDDP). To enhance the local control and reduce the systemic adverse effects, we have been performing intraarterial infusion of CDDP from the bronchial arteries (BAI of CDDP) instead of intravenous administration. In principle, we administered 80 mg/m2 of CDDP intra- arterially twice during the conventionally fractionated radiation therapy of 60 to 70 Gy. The dose of CDDP was changed according to the patient's renal function. Between 1996 and 2001 40 cases with stage III NSCLC were treated definitively. Median age was 75 years. There were 28 squamous cell carcinoma (Sqcca) and 9 adenoca. There were 7 stage IIIA and 33 stage IIIB cases. Average total RT dose was 63.4 Gy and median total CDDP dose was 220 mg. Median follow-up period was 63 months. Median survival time was 27 months. Five-year overall, relapse-free and cause-specific survival rates were 41%, 33% and 56%, respectively. Five-year local relapse-free rate was 57%. As for acute complications, we had only six (15%) grade 3 hematological and 2 (5%) grade 3 pulmonary complications, and we had no severe esophageal complications, which is often a dose-limiting factor. Our survival results of concurrent radiotherapy and BAI of CDDP for the treatment of stage III NSCLC have been promising with a low rate of severe adverse effects. Judging from the high rate of long-term disease-free survivors, disease clearance by chemoradiotherapy might be quite essential to improve the treatment results. (author)