Survival and Side Effects in Non-Small Cell Lung Cancer Patients Treated With Combination of Chemotherapy and Conformal Radiotherapy

Background: Combined modality therapy is standard of care for patients with inoperable locally advanced non-small cell lung cancer (NSCLC), however, insufficient data exist regarding what chemoradiotherapy combination will be the gold standard.

Aim: The study aimed to compare the survival impact and side effects of concurrent versus sequential radiochemotherapy treatment in inoperable stage III non-small cell lung cancer (NSCLC).

Methods: To evaluate the treatment results and prognostic variables, 85 NSCLC patients treated from October 2005 to November 2008 were randomly assigned to one of the two treatment arms. In the first arm (sequential arm), 45 patients received sequential chemotherapy with 4 cycles of carboplatin and etoposide followed by conformal 3-dimensional (3D) radiotherapy (RT). In the second arm (concurrent arm), 40 patients received concomitant chemotherapy with cisplatin and etoposide and conformal RT, followed by two cycles of consolidation chemotherapy with carboplatin and etoposide.

Results: The median survival was 13 months for the patients in the sequential arm and 19 months for those in the concurrent treatment arm (p = 0.0039). The disease-free survival (DFS) was 9 months in the sequential arm and 16 months in the concurrent treatment arm (p = 0.0023). Seven complete responses and 18 partial responses were obtained with sequential treatment. Twelve complete responses and 21 partial responses were obtained in concurrent arm. The differenced were statistically significant p = 0.03. Median survival for patients with complete response in concurrent treatment arm was 36 months versus 18 mounts for a sequential arm; partial response was 27 months versus 16 months and those with stable disease 11 months versus 9 months. Treatment-related toxicities were assessed according to the RTOG/EORTC criteria. Acute esophagitis and incidence of neutropenia were higher with the concurrent than with sequential treatment. Grade 3 esophagitis was characteristic only for concurrent treatment, and it was the reason for radiotherapy interruption, but no longer than 7 days. Secondary anaemia was more frequent in the sequential treatment arm.

Conclusion: The statistically significant differences in survival were suggested that the concurrent chemotherapy and conformal three-dimensional radiotherapy is the optimal strategy for patients with locally advanced NSCLC with acceptable toxicity rates.