S-1 plus cisplatin with concurrent radiotherapy versus cisplatin alone with concurrent radiotherapy for stage III non-sm
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RESEARCH
Open Access
S-1 plus cisplatin with concurrent radiotherapy versus cisplatin alone with concurrent radiotherapy for stage III non-small cell lung cancer: a pilot randomized controlled trial Lei Yao, Shidong Xu*, Jianyu Xu, Chaoyang Yang, Junfeng Wang and Dawei Sun
Abstract Background: We investigated the efficacy and safety of S-1 and cisplatin with concurrent thoracic radiation (SCCR) over cisplatin alone plus concurrent thoracic radiation (CCR) for unresectable stage III non-small-cell lung cancer (NSCLC). Methods: Between January 2009 and November 2011, 40 eligible patients with NSCLC were included and divided randomly into two groups. Twenty patients received SCCR with S-1 (orally at 40 mg/m2 per dose, b.i.d.) on days 1 through 14, cisplatin (60 mg/m2 on day 1) every 4 weeks for two cycles, and radiotherapy (60 Gy/30 fractions over 6 weeks) beginning on day 1. Twenty subjects received CCR (cisplatin and radiotherapy, the same as for SCCR). Results: The 3-year overall response rate was 59.3% and 52.4% for the SCCR and CCR groups, respectively, and the difference was statistically significant, while the median overall survival was 33 months (range, 4–41 months) and 24 months (range, 2–37 months), respectively (P = 0.048). The median progression-free survival was 31 months for SCCR (range, 5–39 months), whereas it was 20 months (range, 2–37 months) for CCR (P = 0.037). The toxicity profile was similar in both groups. Conclusion: In summary, we demonstrated that S-1 and cisplatin with concurrent thoracic radiation was more effective than cisplatin plus radiotherapy in NSCLC patients with acceptable toxicity. Trial registration: Chinese Clinical Trials Register: ChiCTR-TRC-13003997. Keywords: S-1, Cisplatin, Radiotherapy, Non-small-cell lung cancer
Introduction Non-small-cell lung cancer (NSCLC) accounts for 80% of all lung cancer cases, and approximately 30% of all lung cancer patients are diagnosed with stage III disease [1], for which the standard treatment is concurrent chemoradiotherapy [2]. Recent randomized phase III trials have shown that concurrent chemoradiotherapy is superior to chemotherapy followed by radiotherapy in terms of response and survival in these patients [3,4]. However, concurrent chemoradiotherapy is also associated
* Correspondence: [email protected] Department of Chest Surgery, Third Affiliated Hospital of Harbin Medical University, Haping Road No.150, Nangang District, Harbin, Heilongjiang Province 150081, China
with greater acute toxicity, which includes bone marrow suppression and esophagitis, than sequential chemoradiotherapy [5]. S-1 (TS-1, Taiho Pharmaceutical Co., Ltd) is a new oral fluoropyrimidine agent designed to enhance anticancer activity and to reduce gastrointestinal toxicity. It consists of tegafur (a 5-FU Pro-drug), 5-chloro-2, 4dihydroxypyridine (an inhibitor of dihydropyrimidine dehydrogenase), and potassium oxonate (an inhibitor of phosphoribosyl transferase), in a molar ratio of 1:0.4:1. S-1 has been shown to induce a comparable response to the other
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