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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

Background:

• 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

• 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

Patients with locally advanced NSCLC and good performance status should be considered for concurrent chemoradiation in order to optimize local control