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Indian Journal of Medical and Paediatric Oncology
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Year : 1995  |  Volume : 16  |  Issue : 3  |  Page : 156-161

A comparative study of induction chemotherapy and radiotherapy versus radiotherapy alone in non small cell lung cancer : the safdarjung hospital experience.

Dept of Radiotherapy, Safdarjung Hospital, New Delhi, India

Correspondence Address:
R Sharma
Dept of Radiotherapy, Safdarjung Hospital, New Delhi, India

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Source of Support: None, Conflict of Interest: None

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Patients with Stage III Non-small Cell Lung Cancer(NSCLC) continue to pose a therapeutic problem with poor cure rates. In an effort to improve upon the results of treatment in locally advanced NSCLC, a randomized trial of induction chemotherapy and radiotherapy versus radiotherapy alone, was conducted at Safdarjang Hospital, New Delhi from March 1992 to February 1994. The study group treatment protocol consisted of induction chemotherapy comprising of MitomycinC 6mg, mw, Ifosfamide 2 gm/m2 with Mesna and Cisplatinum 50 mg/m2 after prior hydration(MIC). After completing 3 cycles of chemotherapy patients received radiotherapy to the primary lesion and mediastinum to a dose of 50-60 Gy in 5-6 weeks. The control group received radiotherapy alone to the primary lesion and mediastinumm to a dose of 55-65 Gy in five and half to six and half weeks. The 180 patients with histologically proven stage III NSCLC were randomized to receive either the study protocol or radiotherapy alone. Of the 90 patients enrolled into the study group, 6(6.7 percent) patients had complete response and 40(44.4 percent) partial response with 3 cycles of induction chemotherapy. On completion of study protocol treatment, the overall response obtained was 62.2 percent, i.e., 13(14.4 percent) patients had complete response and 43(47.8 percent) had partial response. In the 90 patients in control group 3(3.3 percent) patients had complete response while 39(43.3 percent) had partial response. Thus the overall response was 46.6 percent in the control group. Mean duration of response observed in the study group was 10.6 months as against 6.8 months in control group. With a follow up of 18 months, 16.6 percent of patients in study group and 24.4 percent in control group, who had initially shown response, died due to progressive disease. Patients in the study group tolerated MIC chemotherapy well. Toxicity was generally moderate and manageable. No therapy induced death occurred during the study and no dose reduction/ treatment modifications were required. Common toxicities encountered were nausea and vomiting, which were controlled by proper antiemetic therapy. Myelosuppression was frequent but moderate, and life threatening infections or hemorrhages were not observed. This study demonstrates that induction chemotherapy(MIC regime) and radical radiotherapy appears to be a good therapeutic approach for locally advanced NSCLC with manageable toxicities.

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