Lung Cancer.pdf

152 R. Komaki
A total of 610 patients were enrolled, many of them from M.D. Anderson.
Median survival was 17 months in patients treated with concurrent
chemoradiation with daily fractionation; 16 months in patients treated
with concurrent chemoradiation with twice-daily fractionation; and 14.6
months in patients treated with sequential chemotherapy followed by
daily radiation therapy (Komaki et al, 2000b). Rates of acute grade 3 or
higher nonhematologic side effects were significantly more common
among the patients treated with concurrent chemoradiation with twicedaily
fractionation (63%) than among those treated with concurrent
chemoradiation with once-daily fractionation (50%) (P .011) or sequential
therapy (31%) (P .001).
At present, patients at M.D. Anderson with NSCLC with good performance
status and minimal weight loss are treated with once-daily fractionation
with vinblastine and cisplatin or weekly paclitaxel and carboplatin.
We are conducting an ongoing randomized study in which all patients
receive a total tumor dose of 63 Gy in 1.8-Gy daily fractions with concurrent
paclitaxel and carboplatin with or without shark cartilage as an antiangiogenic
agent. All patients receive 2 cycles of paclitaxel and carboplatin
as induction chemotherapy before concurrent chemotherapy and
radiation therapy. A total of 756 evaluable patients will be required to permit
detection of a 25% difference in median survival.
Superior Sulcus Tumors
Patients with superior sulcus tumors that cannot be treated surgically
should be considered candidates for curative or palliative radiation therapy
with or without chemotherapy. Ahmad and colleagues (1984) reported
on 48 patients with superior sulcus tumors treated with radiation
therapy alone using either cobalt 60 or cesium 137 teletherapy up to a total
tumor dose of 50 to 60 Gy over 5 to 6 weeks. The actuarial 3-year survival
rate was 28%, and the actuarial 5-year survival rate was 21%. There were
no severe complications among the patients treated with radiation therapy
alone except for some fibrotic changes in 1 patient that were recognized
in the radiographs but did not cause any symptoms.
Van Houtte and colleagues (1984) reported on 31 patients with superior
sulcus tumors treated with external-beam high-energy radiation therapy
up to a total tumor dose of 20 to 70 Gy. The overall 5-year survival rate was
18%. Doses below 50 Gy and bone invasion were associated with a higher
local recurrence rate.
Komaki and colleagues (1981) reported on 36 patients with inoperable
superior sulcus tumors who were treated with external-beam radiation
therapy between 1963 and 1977 at the Medical College of Wisconsin. Local
control correlated positively with larger field size and longer median survival.
All patients who survived beyond 2 years had local tumor control,
and no patient survived beyond 2 years if treatment failed locally (i.e., if