Multimodality approaches suitable for stage III non-small cell lung cancer

NEW YORK (Reuters Health) - New research suggests that radiotherapy plus chemotherapy with or without surgical resection are suitable treatment options for patients with stage III non-small cell lung cancer (NSCLC).

"On the basis of the findings of our study, patients should be counseled about the risks and potential benefits of definitive chemotherapy plus radiotherapy with and without a surgical resection (preferably by lobectomy)," Dr. Kathy S. Albain, from Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, and colleagues conclude.

The findings, reported in the July 27th online issue of The Lancet, are based on a study of 429 patients who were randomly assigned to receive induction chemotherapy (cisplatin and etoposide) plus radiotherapy with surgery or induction chemotherapy and definitive radiotherapy, but no surgery.

Median overall survival in each group was similar, around 23 months. Likewise, the number of patients alive at 5 years was not significantly different. In the group that underwent resection if needed, the median overall survival with N0 status at thoracotomy was 34.4 months.

Progression-free survival, by contrast, was significantly higher in the surgery group than in group two: 12.8 vs. 10.5 months (p = 0.017). At 5 years, the numbers of patients without disease progression was 32 in group one and 13 in group two.

In both groups, the main grade 3 and 4 toxicities were neutropenia and esophagitis. Roughly 40% of patients in each group developed neutropenia, while 10% of group one patients and 23% of group two patients developed esophagitis. Eight percent of deaths in group one and 2% in group two were treatment related.

On an exploratory analysis, adding lobectomy, but not pneumonectomy, to chemotherapy plus radiotherapy improved overall survival, the report indicates.

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.