Paclitaxel-based chemo-radiotherapy in NSCLC patients with tumor following surgery

The authors assessed the effectiveness of paclitaxel (Taxol)-based chemo-radiotherapy (combination of chemotherapy and radiation therapy) in non-small cell lung cancer patients (NSCLC) with presence of tumor after surgery. 

The primary treatment for NSCLC is the surgical removal of the affected lobe of the lung (lobectomy) along with the lymph nodes (tiny, bean-shaped organs that help fight infections) surrounding the tumor. During lobectomy some apparently non-tumorous tissues surrounding the tumor are also removed. This is called the ‘resection/surgical margin’. These tissues are later analyzed under the microscope for the presence of cancer (residual tumor). 

The surgery is referred to as R₁ resection if residual tumors are found. The occurrence of residual tumors happens in 4-5% of all lung surgeries. Residual tumors can adversely affect the overall survival of patients. Paclitaxel-based chemo-radiotherapy is a possible treatment option for NSCLC patients with residual tumors.

The authors aimed to evaluate the effectiveness of chemo-radiotherapy with paclitaxel in 46 NSCLC patients (stage II/III) after R₁ resection.

The average age of the patients was 57 years and the average follow-up time was 40 months. Patients survived for an average of 32 months. After one year 97.8% of patients were still alive, after two years 60.9% of patients were still alive, and after three years 36.9% were still alive

The cancer relapsed close to its original site in 19.6% of patients. The average progression-free survival (time following the treatment before the disease progressed) was 23 months. Patients with non-squamous cell (flat cells in the lining of airways) NSCLC survived longer (45.1 months) than those who did not (26.4 months).

Common side effects were low white-blood cell count (93.5%), decreased red-blood cells (89.1%) and low platelet count (89.1%). Other moderate to severe side effects were radiation-induced pneumonitis (inflammation of lung tissues) in 43.5 % of patients and esophagitis (inflammation in the food pipe) in 26.1% of patients. No treatment-related death was reported. 

The authors concluded that paclitaxel–based chemo-radiotherapy was well tolerated and provided promising outcomes in NSCLC patients with residual tumors following lobectomy.

The number of patients (46) in this study was rather low. Further research is needed to ensure the accuracy of the results.