Concurrent Chemoradiotherapy with Low Dose Weekly Gemcitabine III Non-Small Cell Lung Cancer (NSCLC)

Background: Combined chemoradiotherapy (CRT) is the treatment of choice for unresectable stage III NSCLC. Gemcitabine (G) is a novel deoxycitidine analogue that has been proven to be a potent radiosensitizer. Purpose: To demonstrate the efficacy, toxicity and tolerability of low dose Gemcitabine given weekly as radiosensitizer in stage III NSCLC. Patients and Methods: Twenty-five patients with unresectable NSCLC were evaluable with a median age of 54 years (range 44-69). Ten patients (40%) had stage Ilia and 15 patients (60%) had stage Illb. Treatment consisted of gemcitabine 75mg/m^2 day 1 of every week of irradiation (6 courses). Thoracic irradiation was delivered in daily doses of 2Gy to a total dose of 60Gy over 6 weeks. Results: The overall response rate was 56% with complete response (CR) in 5 patients (20%), partial response (PR) in 9 patients (36%), stable disease (SD) in 5 patients (20%) and 6 patients showed progressive disease (PD) (24%). The median overall survival was 15 months (95% CI: 11.2-20.6) and 1 year and 2 year survival rates were 58% and 37% respectively. The most frequent hematologic toxicity was neutropenia (40%) while radiation pneumonitis (32%) was the most frequently observed non-hematologic toxicity followed by esophagitis (24%), nausea and vomiting (20%). One and two year progression-free survival rates were 55% and 28% respectively with median progression free survival 9 months (95% CI: 2.5-17.3). Conclusion: Gemcitabine might be used as radiosensitizer for patients with unresectable stage III NSCLC with feasible, tolerable side effects and considerable response rate. However, further randomized studies are needed to identify the optimal chemoradiotherapy regimens and schedules for treatment of unresectable NSCLC stage III.