Concurrent Versus Sequential Chemoradiotherapy in Stage III Non-Small Cell Lung Cancer-A Comparative Study

Author(s): Aditi Paul Chowdhury, Md. Ruhul Amin Bhuiyan, Md. Ershadul Haque, Abdul Mannan, Abdullah Al Mamun

Background: Non-small cell Lung carcinoma is the most common carcinoma in both worldwide and Bangladesh. Most of them presents with locally advanced disease. Though Concurrent Chemoradiation (CCRT) is the standard approach, Sequential chemoradiotherapy (SCRT) can also be considered in stage III NSCLC. This study’s aim is to compare the local control and toxicity of CCRT and SCRT in stage III NSCLC.

Materials and Methods: Quasi-experimental study was carried out in the Department of Oncology, Khwaja Yunus Ali Medical College and Hospital (KYAMCH), Sirajgonj during the period November 2018 to October 2019. Patients of stage III NSCLC who met the set inclusion criteria were included and distributed in Arm A and B. Treatment schedule for Arm A was Inj. Cisplatin 50 mg/m2 on days 1, 8, 29 and 36 and Inj. Etoposide 50 mg/m2 on days 1-5 and 29-33 concurrently with RT. In arm B, the sequential chemotherapy protocol consisted with Inj. Paclitaxel 200 mg/m2 day 1 and Inj. Carboplatin AUC-6 day 1 for 3 cycles followed by radiotherapy. RT dose was 60 Gy in 30 daily fractions over 6 weeks for both the arms. Every patient was evaluated during and after completion of treatment for response and toxicity. All the informations were recorded, analyzed statistically and results were compiled accordingly.

Results: During the study period a total of 60 patients of stage III NSCLC were included in this study and distributed in A and B. In Arm A 30 patients were enrolled but one patient discontinued treatment. After completion of RT, complete response was observed in 8(27.6%) patients, partial response was seen in 18(62.1%) in Arm A and in Arm B same number had complete response and 17(60.7%) had partial response. P value was 0.7503 which was statistically not significant. At 3rd follow up 5(17.2%) patients had complete response and 7(24.13%) had partial response. In SCRT arm 4(14.3%) had complete response and 8(28.6%) had partial response, P value was 0.161 which was statistically not significant. Various toxicities were observed in this study, most common were esophagitis and pneumonitis but all those were manageable.

Conclusion: It may be said that SCRT with paclitaxel and carboplatin regimen followed by external beam radiotherapy is equally effective like CCRT with cisplatin and etoposide regimen in locoregional control of stage III NSCLC with acceptable toxicity.