Sequential chemoradiotherapy versus radiotherapy in the management of locally advanced non-small-cell lung cancer.
This prospective randomized trial compared neoadjuvant chemotherapy followed by local-regional radiotherapy (study group) with radiotherapy alone (control group) in 506 patients with locally advanced non-small-cell lung cancer. The study group received three cycles of cisplatin, ifosfamide with Mesna, and mitomycin C at 21-day intervals. Radiotherapy was delivered up to a dose of 60 Gy. Evaluable patients numbered 460. In the study group, 228 patients were assessed for tumor response after chemotherapy: 13 (5.7%) had a complete response; 103 (43.2%), a partial response; 48 (21%) showed no change; and 74 patients (31.1%) had progressive disease. These patients then received chest irradiation, which was well tolerated. On completion of radiotherapy, 16.2% of the study group and 6% of the control group had a complete response. No change was seen in 10.1% of study patients and 15.5% of control patients. Respective rates for disease progression were 27.6% and 42.3%. Actuarial 2-year survival was 20% in the study group and 7.4% in the control group.
Sharma
Shantanu
S
Department of Radiotherapy, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, India.
Sharma
Rajiv
R
Bhowmik
Kumar T
KT
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001707:Biopsy, Needle; D001918:Brachytherapy / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
D016685:Mitomycin; D002945:Cisplatin; D007069:Ifosfamide