Background:
Cisplatin and etoposide (EP) is a common chemotherapy protocol for concurrent chemo-irradiation for patient with stage III NSCLC. In 2004 based on phase II studies our center adopted a protocol of weekly low dose Cisplatin (20mg/m2) and Docetaxel ( 20mg/m2 )(PD) with concurrent radiotherapy (RT) 60-66Gy. This is a retrospective comparison of the two regimens treated between Jan 2004 till Sept 2015.
Methods:
Patient demographics, tumour characteristics along with toxicity using (CTCAE 4.0) was collected. Progression free survival (PFS) and overall survival (OS) was calculated from treatment commencement until August 2017.
Results:
81 patients were treated between 2004-2015 with PD/RT; 19 patients were treated between 2008-2015 with EP/RT, patient and tumour characteristics were comparable except for a slight preponderance of males and smokers in the PD/RT group and stage IIIA in EP/RT group.
The PD/RT group experienced significantly lower grade 3/4 heamatological toxicities than the EP/RT group; 4.9% vs 36.9% neutropenia;1.2% vs 10.5% thrombocytopenia and 6.2% vs 10.5% anemia; moderate renal impairment was lower in the PD/RT group 12.3% vs 18.8%. Nausea was higher in EP with grade 3 nausea 10.5%; oesphagitis was similar in both groups however the pneumonitis rate was higher in the EP/RT group at 21.1% Vs 2.5%.
Median PFS was 11.5 months in EP/RT vs 10 months in the PD/RT groups; the OS was 22months in the EP/RT vs 21months PD/RT group which was not significant. 36.8% (7) were alive with no progression in the EP/RT and 27.2 % (22) alive with no progression PD/RT.
Conclusions:
Both the regimens gave acceptable results with a similar PFS and OS which compared well with published studies. The better toxicity profile of the PD/RT regimen warrants a randomised controlled trial. The long study period and the retrospective nature limits firmer recommendations.