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
OncoLink
Last Modified: October 9, 2002

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.

Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Ortho Biotech.