Radiotherapy alone vs. radiochemotherapy in patients with favorable prognosis of clinical stage IIIA non-small-cell lung cancer

Abstract

Purpose: To evaluate the outcome of radiotherapy (RT) vs. radiochemotherapy (RT-CHT) in patients with locally advanced, inoperable non-small-cell lung cancer who had a "favorable" prognosis (stage IIIA, Karnofsky performance score 70-100, no weight loss >5%).

Patients and methods: A total of 222 patients with these characteristics were among 600 patients enrolled into 5 prospective trials between 1988 and 1998, and were treated with either hyperfractionated RT alone (doses of 69.6 and 67.6 Gy when using 1.2 and 1.3 Gy twice a day, respectively) (n = 45) or the same hyperfractionated RT and concurrent CHT (n = 177), which consists of either carboplatin-etoposide (or paclitaxel-carboplatin.

Results: The median times and 5-year overall survival, local progression-free survival, and the distant metastasis-free survival rates for all 222 patients were 33 months, 31 months, and not attained yet, respectively, and 36%, 43%, and 57%, respectively. RT-CHT was superior to RT alone in terms of both overall survival (median survival time, 38 vs. 21 months, respectively; 5-year, 41% vs. 16%, respectively; P < .001) and local progression-free survival (median time to local progression, 38 vs. 22 months, respectively, 5-year local progression-free survival, 48% vs. 23%, respectively; P < .001) but not the distant metastasis-free survival. The most frequent acute high-grade (>3) toxicity was esophageal and bronchopulmonary (8% each) and the most frequent late high-grade toxicity was esophageal (6%). RT-CHT caused only significantly more hematologic high-grade toxicity.

Conclusions: RT-CHT achieved excellent results in this favorable patient population (median survival time, 38 months; 5-year survival, 41%) accompanied with very low toxicity. These results compare favorably with results of other similar studies when using combined RT and CHT, with or without surgery.