title: Comparison of outcomes for patients with unresectable, locally advanced non-small-cell lung cancer treated with induction chemotherapy followed by concurrent chemoradiation vs. concurrent chemoradiation alone.
abstract: OBJECTIVE
  To retrospectively compare outcomes for patients with unresectable locally advanced non-small-cell lung cancer (NSCLC) treated at our institution with concurrent chemoradiation with or without induction chemotherapy.
  
  
  METHODS
  We retrospectively analyzed 265 consecutive patients who received definitive treatment with three-dimensional conformal radiation and concurrent chemotherapy. Of these, 127 patients received induction chemotherapy before concurrent chemoradiation.
  
  
  RESULTS
  The two groups of patients (with induction vs. without induction chemotherapy) were similar in age, performance status, weight loss, histology, grade, and stage. Patients who received induction chemotherapy had better overall survival (median, 1.9 vs. 1.4 years; 5-year rate, 25% vs. 12%; p < 0.001) and distant metastasis-free survival (5-year rate, 42% vs. 23%; p = 0.021). Locoregional control was not significantly different between the two groups. Multivariate analysis showed that induction chemotherapy was the most significant factor affecting overall survival, with a hazard ratio of 0.55 (95% confidence interval 0.40-0.75; p < 0.001). A planned subgroup analysis showed that induction chemotherapy was associated with a significant overall survival benefit for patients with adenocarcinoma or large-cell carcinoma (5-year rate, 24% vs. 8%; p = 0.003) but not for those with squamous cell carcinoma. A multivariate analysis of patients with adenocarcinoma or large-cell carcinoma confirmed that induction chemotherapy was the most significant factor associated with better overall survival, with a hazard ratio of 0.47 (95% confidence interval, 0.28-0.78; p = 0.003).
  
  
  CONCLUSIONS
  Our retrospective analysis suggests that in combination with concurrent chemoradiation, induction chemotherapy may provide a small but significant survival benefit for patients with unresectable locally advanced adenocarcinoma or large-cell carcinoma of the lung.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Huang
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: James D
authors.initials: JD
authors.lastname: Cox
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Guerrero
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Chang
authors.forename: Melinda
authors.initials: M
authors.lastname: Jeter
authors.forename: Yerko
authors.initials: Y
authors.lastname: Borghero
authors.forename: Xiong
authors.initials: X
authors.lastname: Wei
authors.forename: Frank
authors.initials: F
authors.lastname: Fossella
authors.forename: Roy S
authors.initials: RS
authors.lastname: Herbst
authors.forename: George R
authors.initials: GR
authors.lastname: Blumenschein
authors.forename: Cesar
authors.initials: C
authors.lastname: Moran
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000628:therapy*; D004358:Drug Therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome