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Intensive combination chemotherapy treatment with carboplatin and paclitaxel followed by conformal chest radiation therapy appears to be a promising approach for the treatment of patients with advanced non-small cell lung cancer, report researchers at the University of North Carolina.

Approximately 75% of persons who have lung cancer have a type of cancer referred to as non-small cell lung cancer (NSCLC). There are actually many different types of lung cancer that are considered to be NSCLC which are named according to the type of cell within the lung that the cancer originated. These include epidermoid or squamous carcinoma, adenocarcinoma, large cell carcinoma, adenosquamous carcinoma and undifferentiated carcinoma. Treatment options depend on the stage, or extent of spread of the cancer in the body and may include surgery, chemotherapy, radiation and/or biologic therapy (treatment utilizing the patient’s immune system to fight cancer). Patients that have stage III NSCLC have cancer that had spread from the lung to different parts of the body and are said to have an advanced stage of the disease with treatment usually consisting of a combination of chemotherapy and radiation.

The goal of treatment is to achieve the greatest cure rates coupled with the least side effects, so new combinations and doses of anti-cancer therapies are continually being evaluated in clinical trials. Radiation therapy is an effective anti-cancer treatment but can produce considerable side effects such as the occurrence of secondary cancers or tissue burns. Persons with NSCLC showed an increased rate of damage to the esophagus (the tube-like structure that allows food to pass from the mouth to the stomach) from radiation treatments. If side effects become too severe, treatment dosages must be lowered or stopped altogether. Less body area exposure to radiation reduces the risk of these side effects and doctors have been evaluating the utilization of this option with advanced stage NSCLC.

Recently, a new technique has been developed for more precise delivery of radiation therapy directly to the cancer, which can spare healthy tissue from the side effects of radiation. Precise delivery allows for higher doses of radiation to be administered, killing more cancer cells. Three-dimensional conformal radiation utilizes tests that allow physicians to know more accurately where the cancer is located in the body, and radiation treatment can be aimed more precisely at the cancer.

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In a recent clinical trial, 29 patients with stage III NSCLC, who could not have their cancer surgically removed, were treated with combination chemotherapy consisting of carboplatin and paclitaxel as well as conformal radiation given at high doses. The overall response rate was 70% with one complete response. The survival rate of these patients one year after treatment was 69%. From these results, doctors concluded that the high doses of radiation given improves response rates and survival time in patients with advanced NSCLC. The high doses of radiation could be given only because three dimensional conformal radiation techniques were used to accurately locate the cancer, sparing healthy tissue from the side effects of radiation. This study is being continued to better define the overall response and survival times. Persons who have advanced NSCLC may wish to talk to their physicians about participation in ongoing clinical trials of conformal high dose radiation therapy or other types of treatment. Two sources of information on ongoing clinical trials are clinical trials listing services provided by the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients.(

Cancer, Vol 89, No3, pp534-542, 2000).

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