Aims: Two meta-analyses have shown a survival advantage for the addition of concurrent chemotherapy to radiotherapy and other sequential radiochemotherapy in the treatment of inoperable advanced lung cancer. The aims of this study were to examine treatment outcomes (survival, time to progression, response rates and toxicity) in patients with lung cancer treated with sequential chemor adiation and to compare these with outcomes in patients treated with radiation alone.

Materials and Methods; Between December 2010 and November 2012, 138 patients of inoperable Stage 111A and Stage 111B Non small Cell lung cancer (NSCLC) were treated with chemoradiation.. Acute toxicity was recorded, with toxicity graded using the common toxicity criteria version4. The median age was 58 years. All patients were staged with computed tomography and brnchoscopy. After induction chemotherapy 68 patients were treated with radiation alone and 70 patients were treated concurrent chemo radiation. This was due to waiting list problems. The chemotherapy used was paclitaxel 60 mg/m2 weekly with radiotherapy, (the neo adjuvant dose was Paclitaxel 175 mg/m2 with cisplatin 75 mg/m2 3 weekly). External beam radiotherapy was given to the chest (40 Gy/20 fractions/4 weeks) followed by 10 Gy boost in 5 fractions.

Results: Patients benefited to an extent of 3.6 months of median time to progression and 3.42 months of mean survival time without major increases in toxicity. The frequent toxicity in our study was Grade 1 Esophagitis followed by grade 1 pneumonitis

Conclusion: There was a trend towards improved survival with concurrent chemoradiation in this cohort of patients that may become significant with longer follow-up.

Keywords: Lung  carcinoma, chemoradiotherapy, outcome, time to progression,  survival, toxicity.

1. Pathak AK, Bhutani M, Mohan A, Guleria R, Bal S &Kochupillai V. Ind J Chest Diseases Allied Sciences 2004; 46: 191-203.
2. Gandara DR, Chansky K, Albain KS, et al: Consolidation docetaxel after concurrent chemoradiotherapy in stage IIIB non–small-cell lung cancer: Phase II Southwest Oncology Group Study S9504.J ClinOncol 21:2004-2010, 2003
3. NCCN guidelines(2012) for management of NSCLC
4. Fairlamb D et al.:A randomized comparison of radical radiotherapy with or without chemotherapy for patients with non-small cell lung cancer: Results from the Big Lung TrialRadiotherOncol. 2005;75(2):134-140
5. Perez et al. 1980 :patients with IIIA/IIIB treated with RT alone randomized to 2/40 Gy vs. 2/50 Gy vs. 2/60 Gy vs. 4/40 Gy (split-course). RTOG 73–01
6. Blanke C: Phase III trial of thoracic irradiation with or without Cisplatin for locally advanced unresectable non-small-cell lung cancer: a Hoosier Oncology Group protocol  , J ClinOncol. 1995 Jun;13(6):1425-9..
7. Trovo MG: Radiotherapy versus radiotherapy enhanced by Cisplatin in stage III non-small cell lung cancer , Int J Radiat Oncol Biol Phys. 1992;24(1):11-5.
8. Soresi E:A randomized clinical trial comparing radiation therapy v radiation therapy plus cis-dichlorodiammine plati-num (II) in the treatment of locally advanced non-small cell lung cancer, Se-min Oncol. 1988 Dec;15(6 Suppl 7):20-5.)
9. AuperinA:Meta-Analysis of Concomitant versus Sequential Radio chemotherapy in Locally Advanced Non–Small-Cell Lung Cancer , J ClinOncol 2010 May 1;28(13):2181-2190.
10. Exclusive Radiotherapy for Non Small Cell Lung Cancer. A Retrospective Multicentric Study-Received November 21st, 2002; received in a revised form March 24 th, 2003; accepted April 22th 2003.
11. Clinical Lung Cancer, Vol. 12, No. 4, 245-51 © 2011 Elsevier Inc]-2011 Jul;12(4): 245-51. doi: 10.1016/j.cllc.2011.03.026. Epub 2011 Apr 24. Acute esophagitis and late lung toxicity in concurrent chemoradiotherapy trials in patients with locally advanced non-small-cell lung cancer: analysis of the radiation therapy oncology group (RTOG) database.
12. Dillman RO etal; Improved survival in stage 111non-small cell lung cancer.Seven year follow up of CALBG 8433 trial,JNati Cancer Inst 88:1210-1215,1966
13. Sause WT, Scott C, Taylor S, et al: Radiation Therapy Oncology Group (RTOG) 88-08 and Eastern Cooperative Oncology Group (ECOG) 4588: Preliminary results of a phase III trial in regionally advanced unresectable non-small-cell lung cancer. J NatlCancerInst 87:198-205, 1995
14. Gervais R, Ducolone A, Lechevalier T, et al: Conventional radiation (RT) with daily carboplatin (Cb) compared to RT alone after induction chemotherapy (ICT) [vinorelbine (Vr)-cisplatin (P)]: Final results of a randomized phase III trial in stage III unresectablenon small cell lung (NSCLC) cancer— Study CRG/BMS/ NPC/96 of the French Lung Cancer Study Group FNCLCC and IFCT. J ClinOncol 23:n625s, 2005 (suppl 16, abstr 7016)
15. Mote PA, Davey MW, Davey RA, et al: Paclitaxel sensitizes multidrug resistant cells to radiation. Anticancer Drugs 7:182-188, 1996
16. Leonard CE, Chan DC, Chou TC, et al: Paclitaxel enhances in vitro radio-sensitivity of squamous carcinoma cell lines of the head and neck. CancerRes 56:5198-5204, 1996
17. Rudolf M. Huber, Michael Flentje, Michael Schmidt, Barbara Pöllinger, Helga Gosse, Jochen Willner, and Kurt Ulm Simultaneous Chemoradiotherapy Compared With Radiotherapy Alone After Induction Chemotherapy in Inoperable Stage IIIA or IIIB Non–Small-Cell Lung Cancer: StudyCTRT99/97 by the Bronchial Carcinoma Therapy Group JCO -Volume 24 _ Number 27 _ September 20 2006.
18. Kim TH, Dose-volumetric parameters for predicting severe radiation pneumonitis after three-dimensional conformal radiation therapy for lung "
19. Lung Cancer ,vol.1 2012 by Dr. Purvish M. Parikh
20. Maintenance therapy in advanced non-small cell lung cancer: evolution, tolerability and outcomes-J.thoracic oncol.2010.may5(5) 723-34.

Dr Preeya. V

Department of Radiation Oncology, Department of Community Medicine,

Government Medical College, Thiruvananthapuram