Multimodal therapeutic approach for locally advanced NSCLC in everyday practice

Background: Locally advanced non-small cell lung cancer (NSCLC) is a heterogeneous group that can, upon vigorous frontline therapy, be rendered radically resectable. The best approach is a concurrent chemoradiotherapy achieving both local control and control of distant metastases. Methods: 35 patients with locally advanced NSCLC, 17 (48.6%) with squamous cell carcinoma, 12 (34.3%) with adenocarcinoma, 4 (1.1%) NSCLC and 1 with mucoepidermoid and adeno-squamous cancer. All patients received 60 Gy radiation in 2 Gy fractions. SCC patients were treated with cisplatin/etoposide and others with paclitaxel/carboplatin chemotherapy. Upon radiotherapy patients were reevaluated. Those rendered resectable underwent surgery, while others received two cycles of consolidation chemotherapy. Depending on the surgical staging, resected patients received two cycles of adjuvant chemotherapy. Results: Response rate to chemoradiotherapy was 57% while progression occurred in 11.4% patients. No serious adverse events have been reported. 22.2% patients underwent surgery. So far PFS is 14.4 months and 19.4% patients died with OS 33.5 months. We detected marginal invert effect of age on PFS (p=0.059), but no effect of time to treat (p=0.369). Neither variable had any effect on OS (p=0.459 and p=0.547). Disease progression occured localy in 13.9%, intracranialy in 8.3%, intrahepatic in 5.6% and intraabdominaly in 2.8% patients. Conclusion: This real life study confirmed efficiency of concurrent chemoradiotherapy ensuring good and long-lasting response in locally advanced NSCLC. Complimented with surgery, it gives even better results prolonging progression free survival. Results are even better than studies published so far.