This is a long-term follow-up of a landmark study by the West Japan Lung Cancer Group (WJLCG) directly comparing concurrent chemoradiation to sequential chemoradiation for patients with unresectable stage III non-small-cell lung cancer (NSCLC). Patients in both arms of the study received two courses of MVP (Cisplatin, Vindesine, andMitomycin) and 56Gy of thoracic radiotherapy. The radiotherapy was delivered as a continuous course in the sequential arm of the trial but as a split-course in the concurrent arm with a 10-day break after the first 28Gy.
The overall response rates were high: 84% for concomitant treatment and 66.4% for sequential treatment (p=0.0002). This could be due in part to the follow up policy of weekly chest x-rays (CXR) to assess response and CT scans if disease was not measurable by CXR.
Median survival durations were 16.5 months for patients given concomitant treatment and 13.3 months for those who received sequential treatment (p=0.03998).
The survival advantage persisted at 5 years, 15.8% in the concurrent group Vs 8.9% in the sequential group with 11 and 7 evaluable patients respectively. Myelosuppression was more significant in the concurrent group but was manageable.
The Radiation Therapy Oncology Group (RTOG) is expected to report a 3-arm study comparing concurrent conventionally fractionated chemoradiation Vs concurrent hyperfractionated chemoradiation Vs sequential chemoradiation in the year 2000. In this trial, the thoracic radiotherapy dose was 63Gy in a continuous course and chemotherapy was cisplatin/vinblastine. This regimen is considered more conventional by US standards.
From the conclusions of these two trials, hopefully we will be able to reach a consensus regarding optimal treatment for selected patients with unresectable stage III NSCLC.
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