CONCURRENT CHEMORADIATION THE BEST TREATMENT OPTION FOR STAGE III INOPERABLE NSCLC

NEW YORK (Reuters Health) May 06 - Concurrent chemoradiation is associated with the longest survival in patients with advanced non-small cell lung cancer (NSCLC), according to US and Chinese researchers.

However, senior investigator Dr. Feng-Ming Kong of the University of Michigan, Ann Arbor, told Reuters Health, "although high-dose radiation therapy and chemotherapy improve the treatment results, the long-term survival rates from this study remain poor." She added that survival rates are "much better" in patients treated more recently.

In the current study, published in the April issue of the International Journal of Radiation Oncology * Biology * Physics, Dr. Kong and colleagues evaluated 237 patients with unresectable or medically inoperable stage III NSCLC who were treated between 1992 and 2004. The subjects were randomized to radiation alone, sequential chemotherapy and radiation or concurrent chemoradiation.

The median overall survival was 12.6 months. For those given radiotherapy alone, median survival duration was 7.4 months. With sequential chemoradiation, survival was 14.9 months, and with concurrent chemoradiation, 15.8 months. At 5 years, the corresponding rates of overall survival were 3.3%, 7.5% and 19.4%.

The effect of higher radiation doses on survival was independent of whether chemotherapy was given. Dr. Kong pointed out that a phase III trial is currently ongoing "to validate the radiation dose effect in patients with stage III non-small cell lung cancer treated with concurrent chemoradiation."

In recent work as yet unpublished, she observed that "3-year survival rate was 42.6% for stage III, which is probably the best reported in the literature thus far."

In addition, Dr. Kong concluded, University of Michigan researchers are "currently looking at using PET imaging during the course of lung cancer treatment to personalize high dose-radiation therapy. As the tumor becomes smaller during treatment, increasing the radiation dose will become more tolerable because it is targeting a smaller area. We believe such as a strategy would lead to improved treatment outcome in many patients.