Successful low-dose concurrent chemotherapy and radiation for locally advanced or inoperable non-small cell lung carcinoma: a report of six cases.

Many studies now demonstrate high overall response rates with concurrent chemotherapy and radiation (CCR) for locoregionally advanced or inoperable non-small cell lung carcinoma (NSCLC) but often with severe toxicity and only modest improvement in survival beyond 3 years. We report a simple CCR protocol for NSCLC that has resulted in long-term disease-free survival with low toxicity. In this retrospective review, 84 patients with NSCLC were seen between 1985 and 1991. Of these, 10 patients had stage IIIa or IIIb NSCLC without effusion or inoperable NSCLC, with no failed prior treatment at the time of referral for oncology evaluation. Six of these were treated with CCR consisting of three cycles of cisplatin and 5-fluorouracil administered concurrently with radiation treatment followed by maintenance chemotherapy for at least five additional cycles. All six patients treated with this protocol had complete response with minimal side effects. Survival times ranged from 4.5 to more than 10 years. Three patients survived in complete remission; three others were in complete remission at the time of death due to unrelated causes. Stage III NSCLC without effusion and inoperable NSCLC can be treated effectively with concurrent local and systemic treatment without significant toxicity. In patients with complete response, maintenance chemotherapy may overcome residual microscopic systemic disease, leading to long-term survival and possible cure. The CCR strategy that resulted in this favorable outcome is noteworthy and should be pursued in larger numbers of patients.