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Open Access Research article

Concurrent chemoradiotherapy with tomotherapy in locally advanced non-small cell lung cancer: a phase i, docetaxel dose-escalation study, with hypofractionated radiation regimen

Alessandra Bearz1*, Emilio Minatel2, Imad Abu Rumeileh2, Eugenio Borsatti3, Renato Talamini4, Giovanni Franchin2, Carlo Gobitti2, Alessandro Del Conte5, Marco Trovò2 and Tanja Baresic3

Author Affiliations

1 Medical Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy

2 Radiation Oncology Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy

3 Nuclear Medicine Department, National Cancer Institute of Aviano (PN), Aviano (PN), Italy

4 Division of Epidemiology and Biostatistics, National Cancer Institute of Aviano (PN), Aviano (PN), Italy

5 General Hospital, Pordenone, Italy

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BMC Cancer 2013, 13:513  doi:10.1186/1471-2407-13-513

Published: 31 October 2013

Abstract

Background

Concurrent chemo-radiotherapy is demonstrately superior to sequential chemo-radiotherapy in the treatment of advanced Non-Small-Cell Lung Cancer not suitable for surgery. Docetaxel is considered to enhance the cytotoxic effect of radiotherapy on the tumour cells. Tomotherapy (HT) is a novel radiotherapeutic technique, which allows the delivery of Image Guided-IMRT (IG-IMRT), with a highly conformal radiation dose distribution.

The goal of the study was to estimate tolerability of Docetaxel concurrent with IMRT and to find the maximum tolerated dose of weekly Docetaxel concurrent with IMRT delivered with HT Tomotherapy after induction chemotherapy with Cisplatin and Docetaxel in patients affected with stage III Non-Small Cell Lung Cancer.

Methods

We designed a phase I, dose-finding study to determine the dose of weekly Docetaxel concurrent with Tomotherapy after induction chemotherapy, in patients affected by Non-Small Cell Lung Cancer with Stage III disease, not suitable for surgery.

Results

Concurrent weekly Docetaxel and Tomotherapy are feasible; we did not reach a maximum tolerated dose, because no life-threatening toxicity was observed, stopping the accrual at a level of weekly docetaxel 38 mg/m2, a greater dose than in previous assessments, from both phase-I studies with weekly docetaxel alone and with Docetaxel concomitant with standard radiotherapy.

Conclusions

Concurrent weekly Docetaxel and Tomotherapy are feasible, and even with Docetaxel at 38 mg/m2/week we did not observe any limiting toxicity. For those patients who completed the combined chemo-radio treatment, median progression-free survival (PFS) was 20 months and median overall survival (OS) was 24 months.