title: Can we optimize chemo-radiation and surgery in locally advanced stage III non-small cell lung cancer based on evidence from randomized clinical trials? A hypothesis-generating study.
abstract: OBJECTIVE
  Improved local tumor control (LC) improves survival of patients with non-small cell lung cancer (NSCLC). We estimated the capability of surgical and non-surgical options to improve LC further in this disease.
  
  
  METHODS
  Eligible studies were phase III trials reporting 2-year survival data as well as the incidence of LC and/or distant metastases. Effect estimates, as well as the statistical uncertainty of these, were combined in order to estimate the benefit in terms of LC from combining multiple modalities.
  
  
  RESULTS
  It was estimated that the highest rates of LC can be obtained with high-dose concurrent chemo-radiation followed by surgery. In this situation, escalating the pre-operative radiation dose from 45 to 66 Gy, delivered concurrently with chemotherapy, could increase LC from 58% to 76%. Toxicity may also be higher, but could not be estimated. Without surgery, the gain in LC from concurrent chemo-radiation versus sequential, corresponds to a radiation dose increase from 65 to 72 Gy.
  
  
  CONCLUSIONS
  We hypothesize that high-dose concurrent chemo-radiation followed by surgery could be superior to other current treatment approaches for selected patients with stage III NSCLC, provided toxicity would be low. At present, high-dose concurrent chemo-radiation followed by surgery should be considered experimental.
authors: Department of Radiation Oncology, Maastro Clinic, Maastricht University Medical Center, Maastricht, The Netherlands. dirk.deruysscher@maastro.nl
authors: Dirk
authors: D
authors: De Ruysscher
authors: Cary
authors: C
authors: Dehing
authors: Søren M
authors: SM
authors: Bentzen
authors: Ruud
authors: R
authors: Houben
authors: André
authors: A
authors: Dekker
authors: Rinus
authors: R
authors: Wanders
authors: Jacques
authors: J
authors: Borger
authors: Monique
authors: M
authors: Hochstenbag
authors: Liesbeth
authors: L
authors: Boersma
authors: Gijs
authors: G
authors: Geskes
authors: Anne-Marie C
authors: AM
authors: Dingemans
authors: Gerben
authors: G
authors: Bootsma
authors: Guido
authors: G
authors: Lammering
authors: Philippe
authors: P
authors: Lambin
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic