After an initial chemotherapy treatment, radiation may be a better choice than surgery for patients with stage IIIA non-small-cell lung cancer, according to a randomized controlled trial published in the March 21 Journal of the National Cancer Institute. The authors suggest that a combination of chemotherapy and radiation should be the preferred treatment option for these patients.
Approximately 80 percent of all lung cancers are non-small-cell lung cancers (NSCLC), and of those patients diagnosed with NSCLC, about 30 percent have locally advanced stages IIIA or IIIB. Previous studies have shown that treating stage IIIA patients with chemotherapy before surgery increases the survival rate compared with patients receiving only surgery. The researchers had originally hypothesized that surgery would be more effective than radiation after chemotherapy treatment.
Jan van Meerbeeck, M.D., Ph.D., of the University Hospital of Ghent in Belgium, and colleagues from the European Organization for Research and Treatment of Cancer (EORTC) recruited 579 eligible patients from 41 institutions into the trial between December 1994 and December 2002. All of the patients were diagnosed with stage IIIA-N2 NSCLC that had progressed so far that it could not be completely removed by surgery. The patients were first given three cycles of platinum-based chemotherapy. Those who responded to the treatment--61 percent of the initial group--were then randomly assigned to receive either surgery or radiation, 167 and 165 patients respectively.
The researchers found that surgery, compared to radiation, did not improve survival after treatment with chemotherapy. The median survival time for surgical patients was 16.4 months versus 17.5 months for patients who were treated with radiation. And the 5-year overall survival rate for surgical patients was 15.7 percent, compared with 14 percent for patients who received radiation. Although the survival rates for the two groups were very similar, the authors concluded that radiation was the preferred treatment because of its lower rate of complications and mortality in lung cancer patients.
"These results are important because several centers routinely use...chemotherapy followed by surgery to treat patients with this stage of disease based on small randomized studies that showed that surgery alone is inferior to...chemotherapy and surgery in stage IIIA patients," the authors write.
In an accompanying editorial, David Johnson, M.D., of the Vanderbilt-Ingram Cancer Center in Nashville, and colleagues discuss how surgeons and oncologists are likely to react to this study, as well as the challenges that each group faces in trying to treat this disease. "Accordingly, these data will be thoroughly parsed by surgeons, radiation oncologists, and medical oncologists alike to assess how each specialty's contribution might be improved and the negative aspects minimized," the authors write.
Reference: van Meerbeeck JP, Kramer GWPM, Van Schil PEY, Legrand C, et al. Randomized Controlled Trial of Resection Versus Radiotherapy After Induction Chemotherapy in Stage IIIA-N2 Non-Small-Cell Lung Cancer. Journal of the National Cancer Institute, 2007; 99: 442-450
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