Concurrent Chemo-Radiation Results in Equivalent Local and Overall Outcome as Induction Chemotherapy Followed by Surgery for Clinical Stage IIIA Non-Small Cell Lung Cancer

Reviewer: William Levin, MD
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Last Modified: October 9, 2002

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Presenter: N.A. Taylor
Presenter's Affiliation: Department of Radiation Oncology, UT M.D. Anderson Cancer Center, Houston, TX, USA
Type of Session: Scientific

Background

  • In this study, investigators looked at 2 different treatment regimens for clinical stage IIIa non-small cell lung cancer (NSCLC).

Materials and Methods

  • This is a retrospective study.
  • 107 patients received either a) induction chemotherapy followed by surgery (C/S), or b) concurrent chemo-irradiation (CRT).
  • Patient characteristics were balanced between the two groups. However, mediastinoscopy was not routinely used for staging.
  • In the C/S group, induction chemotherapy included 2-4 cycles of cisplatin-based chemotherapy followed by lobectomy and mediastinal lymph node dissection.
  • Post-op RT, which was given to 35 patients, was done at the discretion of the physician
  • CRT consisted of 3 cycles of cisplatin-based chemotherapy given concurrently with RT, which was 60-63 Gy/30-35 fractions in 27 patients, and 69.6 Gy/b.id. fractionation in the remainder of patients.
  • Median follow-up was 20 months in all patients and 32 months in surviving patients.

Results

  • 5 year overall survival was not statistically significant between the two groups (33% for C/S vs. 30% for CRT).
  • Likewise, disease-free survival was not different (24% C/S vs. 23% CRT).
  • Local control and rate of distant metastases were also similar.
  • Patients who responded to chemotherapy prior surgery had significantly better 5-y OS (50%), versus those who had stable or progressive disease (16%) p=0001.
  • Post-operative radiation therapy improved local control but did not affect overall survival.

Author's Conclusions

  • Patients with clinical stage IIIa NSCLC have equivalent survival and local control following treatment with either C/S or CRT.
  • Post-operative RT significantly improves local control in patients treated with C/S, without improving overall survival.

Clinical/Scientific Implications

  • This study suggests that there is equivalency between the two treatment regimens for clinical stage IIIa NSCLC.
  • However, one must consider that mediastinoscopy was generally not done, so there actually may by a difference in lymph node status between groups. Additionally, radiation technique varied significantly, with some patients getting hyperfractionation.
  • In general, it must be remembered that this was a retrospective review and therefore a prospective randomized study would give the strongest support for the authors? conclusions. Unfortunatly, it is very difficult to accrue patients a prospective randomized trial that randomizes between surgery and a non-surgical arm.

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