Concurrent Hyperfractionated Chemoradiation Versus Conventional Fractionated Chemoradiation with Low-dose Weekly Paclitaxel in Locally Advanced Non–Small-Cell Lung Cancer in a Tertiary Cancer Center in Kashmir: A Prospective Study
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2019, Vol 6, Issue 11
Abstract
Introduction: Lung cancer is the most common cancer worldwide and has a poor prognosis but integration of chemoradiation has led to an increase in overall survival time and percentage of cured patients with acceptable toxicity. Purpose: The purpose of this study was to compare the efficacy of hyperfractionated (HFX) radiotherapy with conventional radiotherapy and weekly concurrent paclitaxel in stage IIB/III non-small-cell lung cancer (NSCLC). Materials and Methods: A total of 60 patients were enrolled, of which 30 patients were given twice daily radiotherapy (1.2 Gy each) to a total of 72 Gy over 5–6 weeks and 30 patients were given single daily fraction (2 Gy) to a total of 66 Gy for the same duration to achieve a comparable biological effective dose. Both groups received weekly 50 mg/m2 paclitaxel. Results: An overall response of 83.3% versus 56.6% with a partial response of 70% versus 53.3% and complete response (CR) of 13.3% versus 3% was seen in HFX radiotherapy versus conventional radiotherapy which was statistically significant (P = 0.04). 10 of 25 patients and 11 of 17 patients who achieved response in study and control groups, respectively, progressed. The median survival of patients in HFX radiotherapy arm was 18 months, compared to 9 months in conventional radiotherapy arm. The median time to local recurrence was 19 versus 11 months with local recurrence-free survival of 72% versus 66% at 1 year follow-up. The 1 and 2 year survival rates were 76% and 40% in study arm and 50% and 26% in control arm (P - 0.005). Esophagitis (70% vs. 63.3%), skin reaction (70% vs. 63.3%), and radiation-induced pneumonitis (50% vs. 43.3%) were the common toxicities with no statistical significance between the two groups. Overall, there was mild chemotherapy-related toxicity. Conclusions: The combination of HFX radiation with weekly paclitaxel is effective treatment with a moderate degree of toxicity in stage IIB/III NSCLC. An average response to treatment and the use of lesser drugs have made us to consider this therapy in locally advanced NSCLC.
Authors and Affiliations
Wani Y Nahida, Subiya Kaneez, Bhat Tanveer, Mohd Ashraf, Muhib Ul Haq, Abdul Majeed, Sanaullah Kuchay
Keywords
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