Neoadjuvant chemotherapy and concomitant boost radiotherapy in locally advanced non-small cell lung cancer

This Phase II study was designed to assess the possibility of increasing local control and decreasing distant metastasis by using neoadjuvant chemotherapy, and concomitant boost radiotherapy which was used to prevent accelerated repopulation in locally advanced non-small cell lung cancer. Thirty-one patients with stage IIIA and IIIB non-small cell lung cancer were included into this phase II study. Two cycles neoadjuvant cisplatin and vinorelbine were applied. This was followed by thoracic radiotherapy of 64.4 Gy. Response evaluation was performed 4 weeks after the radiotherapy. One year overall survival, progression-free survival and distant disease-free survival rates were 38.4%, 42.1% and 65%, respectively. An objective response was observed in 75% of patients. Different doses of cisplatin affected objective response rate and distant disease-free survival. Grade 3-4 toxicities occurred in 17 patients with chemotherapy and 9 patients with radiotherapy. There was no late grade 3-4 toxicity. Neoadjuvant chemotherapy and concomitant boost accelerated radiotherapy seems difficult to be considered as a standard treatment method. The ratio of objective response and survival is not at desirable level even though it is higher than the conventional technique.