الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Lung cancer is the most prevalent and lethal cancer in the world, accounting for more than 1 million new cases per year (American Cancer Society, 2006). Non small cell lung cancer accounts for 80-85% of all lung cancers (Izmirli et al., 2005). Concurrent chemoradiotherapy has proven to be more effective than chemotherapy followed by radiotherapy. Full dose consolidation chemotherapy after concurrent chemoradiation showed an improvement of survival (Maas et al., 2007). The aim of this study is to investigate the efficacy of neoadjuvant chemoradiotherapy (docetaxel-cisplatin) in stage III non small cell lung cancer compared with traditional chemotherapy protocol (vepsid-cisplatin). Moreover attention was paid to toxicity of the therapy and its impact on the quality of life as the later is not less improtant than the response gained and its effect on down staging & feasibility to surgery after treatment. Also this work was done to examine prognostic factors for patients not benefiting from surgery. This study included 76 patients with stage III non small cell lung cancer. The study included 2 arms: the first arm was a prospective study on fourty patients (group I) who received 2 courses of combination chemotherapy docetaxel ( 75mg/m2) day 1, and cisplatin (40 mg/m2) day 1,2 every 3 weeks with concurrent radiotherapy with a dose of 40-45 Gy in 23 sittings then assessed for surgery. Five patients were scheduled for surgery while 35 patients were inoperable. All patients received another 4 courses of the previous chemotherapy regimen either after surgery or radiotherapy course. The second arm was a retrospective study for thirty-six patients (group II) who received vepsid (100mg/m2) day 1,2,3 + cisplatin (100mg/m2) day 1 every 3 weeks with concurrent radiotherapy with a dose of 40-45 Gy in 23 sittings. The study revealed that the mean age was 53.21±10.29 years and 55.48±10.62 years in group I and II respectively with a male to female ratio of 4.7:1 and 5:1 in group I and II respectively. Higher percentage of smokers and G1PS patients was found in both groups. Squamous cell carcinoma was the most common histopathological type in group I (47.5%) while adenocarcinoma was the most common histopathological type in group II. Cough and haemoptysis were the most common presenting symptoms, while diminished air entry and chest wheez were the most common presenting signs. Most of cases presented as stage IIIB, T1 tumor status, N2 nodal status. No statistically significant relations were found between response rate and age, sex, PS, smoking, histopathology, clinical tumor and nodal status. Statistically significant difference was found between response rate, stage of tumor and different treatment modalities. Overall response rate was 82.5% in group I and 61% in group II. Median overall survival was 11 months in group I and 9 months in group II. Median progression free survival was 11 months in group I and 8 months in group II. There was a statistically significant relation between the response rate and overall survival and progression free survival. Toxicity was higher with the use of docetaxel-cisplatin as regard skin rash, dry skin and oedema than in using vepsid-cisplatin. Recommendations: • Concurrent chemoradiotherapy in combination with full-dose chemotherapy should be the standard of care for NSCLC stage IIIA and IIIB. • Surgery seems to be promising for certain subgroups of patients who received and responded to two or three cycles of chemotherapy then resection of the tumor completely then continuation of chemotherapy. • More research has to be done in optimizing radiotherapy schedules and chemotherapy schemes in order to minimize toxicity. • Novel therapeutics have to be introduced in the combined modality approach of stage III NSCLC. • Early detection of lung cancer and regular screening of the smokers, as ”prophylaxis is better than treatment”.