Impact of Tumor Control on Survival in Unresectable Stage III Non-Small Cell Lung Cancer (NSCLC) Treated with Concurrent Thoracic Radiotherapy (TRT) and Chemotherapy (CT).

Jason Lee, MD
OncoLink Assistant Editor
Last Modified: May 23, 2000

Presenter: K. Furuse
Affiliation: Health Insurance Union Osaka Cent Hosp, Osaka


  • Radiation therapy and chemotherapy is standard therapy in good performance status patients with locally advanced unresectable non-small cell lung cancer (NSCLC)

  • A previously reported study by Furuse et al (J Clin Oncol 1999;17:2692) demonstrated that the use of concurrent cisplatin-based chemotherapy with thoracic radiation therapy has been shown to be superior to sequential chemotherapy and radiation

  • This study attempts to assess patterns of failure in the previously reported randomized trial

Materials and Methods:

  • 293 patients with unresectable stage III NSCLC were randomized to the following treatment arms: - CON: Concurrent chemotherapy with cisplatin, mitomycin and vindesine and split course radiation therapy to 56 Gy with a 10 day break - SEQ: Sequential chemotherapy with cisplatin, mitomycin, and vindesine followed by continuous course radiation therapy to 56 Gy

  • Patients in both arms received two courses of chemotherapy every 28 days

  • Patients were assessed for response rates, type of first relapse (local or distant), and overall survival

  • Response rates and overall survival were significantly higher in the CON arm compared with the SEQ arm, as previously reported

  • 117 (79%) of 148 patients in the CON arm experienced disease relapse and 120 (83%) of 145 patients in the SEQ arm experienced disease relapse

  • Local relapse occurred in 50 (34%) patients in the CON arm compared with 65 (45%) patients in the SEQ arm, a difference which was not significant

  • The local failure free interval was longer in the CON arm (median time 10.6 mos) compared with the SEQ arm (median time 8.0 mos)

  • The number of patients with distant failure and the freedom from distant failure was equivalent in both arms

  • The chemotherapy dose-intensity in the CON arm was less than planned due to grade 4 leukopenia
Authors' Conclusions

  • Concurrent chemoradiation results in improved response rates, local intrathoracic tumor control, and overall median survival time compared with sequential chemoradiation

  • The improvement in median survival appears to be related to better local control with concurrent therapy
Clinical/Scientific Implications:
    Patients with locally advanced NSCLC and good performance status should be considered for concurrent chemoradiation in order to optimize local control