Paclitaxel and Cisplatin with Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Stage IIIB Non-small Cell Lung Cancer

$\underline{Purpose}$: Combined modality therapy including chemotherapy, surgery and radiotherapy is considered the standard of care for the treatment of stage III non-small cell lung cancer (NSCLC). This study was conducted to evaluate the efficacy of paclitaxel and cisplatin with induction chemotherapy followed by concurrent chemoradiotherapy for stage IIIB NSCLC. $\underline{Materials\;and\;Methods}$: Between July 2000 and October 2005, thirty-nine patients with stage IIIB NSCLC were treated with two cycles of induction chemotherapy followed by concurrent chemoradiotherapy. The induction chemotherapy included the administration of paclitaxel ($175\;mg/m^2$) by intravenous infusion on day 1 and treatment with cisplatin ($75\;mg/m^2$) by intravenous infusion on day 1 every 3 weeks. Concurrent chemoradiotherapy included the use of paclitaxel ($60\;mg/m^2$) plus cisplatin ($25\;mg/m^2$) given intravenously for 6 weeks on day 43, 50, 57, 71, 78 and 85. Thoracic radiotherapy was delivered with 1.8 Gy daily fractions to a total dose of $54{\sim}59.4\;Gy$ in $6{\sim}7$ weeks (median: 59.4 Gy). $\underline{Results}$: The follow up period was $6{\sim}63$ months (median: 21 months). After the induction of chemotherapy, 41.0% (16 patients) showed a partial response and 59.0% (23 patients) had stable disease. After concurrent chemoradiotherapy, 10.3% (4 patients) had a complete response, 41.0% (16 patients) had a partial response, and the overall response rate was 51.3% (20 patients). The 1-, 2-, 3-year overall survival rates were 66.7%, 40.6%, and 27.4% respectively, with a median survival time of 20 months. The 1-, 2-, 3-year progression free survival rates were 43.6%, 24.6%, and 24.6%, respectively, with median progression free survival time of 10.7 months. Induction chemotherapy was well tolerated. Among 39 patients who completed the entire treatment including chemoradiotherapy, 46.3% (18 patients) had esophagitis greater than grade 3 and 28.2% (11 patients) had radiation pneumonitis greater than grade 3. $\underline{Conclusion}$: Paclitaxel and cisplatin with induction chemotherapy followed by concurrent chemoradiotherapy for stage IIIB NSCLC seems to be an effective treatment. Occurrence of esophagitis and pneumonitis represents a significant morbidity and suggests a modification of the treatment regimen, either with the chemotherapy schedule or with radiotherapy treatment planning.

IIIB 병기 비소세포폐암에서 Paclitaxel과 Cisplatin을 이용한 선행항암화학요법과 동시 항암화학방사선치료

목 적: III 병기 비소세포폐암의 치료는 항암화학요법, 수술, 방사선치료가 포함된 병용치료가 표준방법으로 알려져 있다. 본 연구에서는 IIIB 병기 비소세포폐암에서 paclitaxel과 cisplatin을 이용한 선행항암 화학요법과 동시 항암화학방사선치료를 시행하여 그 효과에 대하여 알아보고자 하였다. 대상 및 방법: 2000년 7월부터 2005년 10월까지 IIIB 병기 비소세포폐암으로 선행항암화학요법과 동시 항암화학방사선치료를 받았던 39명을 대상으로 하였다. 선행항암화학요법은 3주 간격으로 paclitaxel ($175\;mg/m^2$)과 cisplatin ($75\;mg/m^2$)을 1일째와 21일째 정맥투여하였다. 동시 항암화학요법은 43일째, 50일째, 57일째, 71일째, 78일째, 85일째 paclitaxel ($60\;mg/m^2$)과 cisplatin ($25\;mg/m^2$)을 정맥투여하였다. 흉부방사선치료는 1회 1.8 Gy씩, 주 5회 분할조사 하였으며 총방사선량은 $54{\sim}59.4\;Gy$이었다(중앙값: 59.4 Gy). 결 과: 추적관찰기간은 $6{\sim}63$개월이었으며 중앙추적관찰기간은 21개월이었다. 선행항암화학요법 후 치료반응은 부분반응 41.0% (16명), 무반응 59.0% (23명)였다. 동시 항암화학방사선치료 후 치료반응은 완전관해가 10.3% (4명), 부분반응 41.0% (16명), 무반응 49.7% (19명)로 치료 반응률은 51.3%였다. 1년, 2년, 3년 생존율은 각각 66.7%, 40.6%, 27.4%였으며 중앙 생존기간은 20개월이었다. 1년, 2년, 3년 무진행 생존율은 각각 43.6%, 24.6%, 24.6%였으며 중앙 무진행 생존기간은 10.7개월이었다. 동시 항암화학방사선치료 후 부작용으로 3도 이상의 식도염은 46.3% (18명), 폐렴은 28.2% (11명)에서 발생하였다. 결론: IIIB 병기 비소세포폐암에서 paclitaxel과 cisplatin을 이용한 선행항암화학요법과 동시 항암화학방사선치료를 시행한 결과 비교적 효과적이었다. 그러나 식도염과 폐렴이 많아 부작용을 줄이기 위해 적절한 항암제의 선택 또는 방사선치료와의 병용치료의 변화가 필요할 것으로 판단되었다.