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DeRose, Cho, and Choy: Management of Locally Advanced Non-small Cell Lung Cancer
Original Article

J Lung Cancer 2009;8(1):1-7.

Published online: 10 January 2009

DOI: https://doi.org/10.6058/jlc.2009.8.1.1

Management of Locally Advanced Non-small Cell Lung Cancer

Paul DeRose, M.D., Jaeho Cho, M.D., Ph.D., Hak Choy, M.D.

Department of Radiation Oncology, UT Southwestern Medical Center at Dallas, Dallas, USA

Address for correspondence Hak Choy, M.D. Department of Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, 5801 Forest Park Rd., Dallas, Texas 75390-9183, USA Tel: 1-214-645-7600 Fax: 1-214-645-7622 E-mail: Hak.Choy@UTSouthwestern.edu

Received 18 April 2009       Accepted 13 May 2009

Copyright © 2009 Korean Association for the Study of Lung Cancer

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Locally advanced Non-small cell lung cancer (NSCLC) is a commonly encountered diagnosis. Historically the treatment of locally advanced NSCLC has involved radiation therapy. Clinical trials have shown a benefit to the addition of chemotherapy. In recent years studies have further defined the role of chemotherapy by provided data showing the benefit of concurrent chemotherapy and radiation therapy followed by consolidation with more chemotherapy. Technological advances in radiation therapy have made dose escalation feasible and the current treatment paradigm is now evolving further as dose escalation data becomes available.

Keywords: Non-small cell lung cancer, Combined modality therapy

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Tables

Table 1.
Multicenter Phase III Randomized Controlled Trials Comparing Sequential Chemoradiation vs. Radiation Alone
Study Sequence Pts RT dose (Gy) CT Local-regional control Median survival (months) Overall survival Acute≥ grade 3 toxicity (%)
3 yr (%) 5 yr (%) 3 yr (%) 5 yr (%)
CALGB 8433 (2,3) qdRT 77 60 N/A 6 5 9.6 6 6 7
  CT→ qdRT 78 60 cddp/vinblastine 18 6 13.7 24 17 3
RTOG 8808 (6,7) qdRT 152 60 N/A n.r. n.r. 11.4 11 5 1
  CT→ RT 152 60 cddp/vinblastine n.r. n.r. 13.8 17 8 1
  bidRT 154 69.9 N/A n.r. n.r. 12.3 14 6 3
CEBI 138 (4,5) qdRT 167 65 N/A 17 (1 yr) n.r. 10 4 3 3
  CT→ qdRT 165 65 VCPC 15 (1 yr) n.r. 12 12 6 5

RT: radiotherapy, CT: chemotherapy, n.r.: not reported, qd: daily, bid: twice daily, cddp: cisplatin, VCPC: vindesine, cyclophosphamide, cisplatin, and lomustine, Pts: number of patients

Table 2.
Multicenter Phase III Randomized Controlled Trials Comparing Concurrent with Sequential Chemoradiotherapy
Study Sequence Pts RT dose (Gy) CT Locoregional control Median survival (months) Overall survival Acute ≥ grade 3 esophagitis (%)
3 yr (%) 5 yr (%) 3 yr (%) 5 yr (%)
West Japan lung cancer CT→ qdRT 158 56 MVP n.r. n.r. 13.3 15 9 2
Group (WJLCG) (11) CT+qdRT 156 56 (split course) MVP n.r. n.r. 16.5 22 16 3
RTOG 9410 (8,9) CT→ qdRT 201 60 cddp/vinblastine n.r. n.r. 14.6 n.r. 10 4
  CT+qdRT 201 60 cddp/vinblastine n.r. n.r. 17 n.r. 16 23
  CT+bidRT 193 69.6 cddp/etoposide n.r. n.r. 15.1 n.r. 13 46
Czech republic CT→ qdRT 50 60 cddp/vinorelbine 40% n.r. 12.9 9.5 n.r. 4
study (10) CT+qdRT 52 60 cddp/vinorelbine 58% n.r. 16.6 18.6 n.r. 18

RT: radiotherapy, CT: chemotherapy, qd: daily, bid: twice daily, MVP: mitomycin, vindesine, and cisplatin, cddp: cisplatin, n.r.: not reported, Pts: number of patients

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