Dose Escalation of Gemcitabine Is Possible With Concurrent Chest Three-Dimensional Rather Than Two-Dimensional Radiotherapy: A Phase I Trial in Patients With Stage III Non-Small-Cell Lung Cancer

Ralph G Zinner, Ritsuko Komaki, James D. Cox, Bonnie S Glisson, Katherine M Pisters, Roy S. Herbst, Merrill S Kies, Zhongxing Liao, Waun K. Hong, Frank V Fossella

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Purpose: To determine in a Phase I study the maximum tolerated dose of weekly gemcitabine concurrent with radiotherapy in locally advanced non-small-cell lung cancer (NSCLC), as well as the relationship between the volume of the esophagus irradiated and severe esophagitis. Methods and Materials: Twenty-one patients with Stage III NSCLC received gemcitabine initially at 150 mg/m2/wk over 7 weeks concurrently with chest radiotherapy to 63 Gy in 34 fractions. The first 9 patients underwent treatment with two-dimensional (2D) radiotherapy; the remaining 12 patients, with three-dimensional conformal radiotherapy (3D-CRT) and target volume reduced to clinically apparent disease. Consolidation was 4 cycles of gemcitabine at 1000 mg/m2/wk and cisplatin 60 mg/m2. Results: In the 2D group, the dose-limiting toxicity, Grade 3 esophagitis, occurred in 3 of 6 patients in the 150-mg/m2/wk cohort and 2 of 3 patients in the 125-mg/m2/wk cohort. No cases of Grade 3 esophagitis occurred at these doses in the 3D group. At gemcitabine 190 mg/m2/wk, 2 of 6 patients in the 3D cohort had Grade 3 esophagitis. The mean percentages of esophagus irradiated to 60 Gy were 68% in the 2D cohort and 18% in the 3D cohort. Conclusions: We could not escalate the dose of gemcitabine with concurrent radiotherapy when using 2D planning because of severe acute esophagitis. However, we could escalate the dose of gemcitabine to 190 mg/m2/wk when using 3D planning. The Phase II dose is 150 mg/m2/wk. Three-dimensional CRT permitted the use of higher doses of gemcitabine.

Original languageEnglish (US)
Pages (from-to)119-127
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume73
Issue number1
DOIs
StatePublished - Jan 1 2009

Keywords

  • Concurrent 3-D
  • Gemcitabine
  • Non-small-cell lung cancer
  • Phase I
  • Radiotherapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Fingerprint Dive into the research topics of 'Dose Escalation of Gemcitabine Is Possible With Concurrent Chest Three-Dimensional Rather Than Two-Dimensional Radiotherapy: A Phase I Trial in Patients With Stage III Non-Small-Cell Lung Cancer'. Together they form a unique fingerprint.

  • Cite this