LOS ANGELESPatients with locally advanced non-small-cell lung cancer and a good performance status have better overall survival and a lower risk of local-regional progression if they receive concomitant chemoradiation instead of sequential chemoradiation, according to a meta-analysis from the NSCLC Collaborative Group presented at this year's ASTRO meeting (abstract 9). The tradeoff was a higher risk of severe esophagitis.
"There is level I evidence of the survival benefit with the addition of either sequential or concomitant chemotherapy to radiotherapy vs radiotherapy alone among good performance status patients with stage III non-small-cell lung cancer," said presenting author Walter J. Curran, MD. "This meta-analysis seeks to compare the relative benefits of concomitant chemoradiation with sequential chemoradiation, based on those trials that have studied this question."
To be eligible for inclusion in the meta-analysis, trials had to be randomized, controlled trials comparing concomitant vs sequential chemoradiation among patients with unresected, locally advanced NSCLC who had not received previous treatment, said Dr. Curran, profesor of radiation oncologist at Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia.
In addition, accrual had to be completed before 2004. Individual patient data were used for the meta-analysis, and outcomes were determined according to intention to treat.
The investigators identified seven eligible trials, and individual patient data were available for six of them, for a total of 1,205 patients with a median follow-up of 5 years, Dr. Curran said.
Two trials used the same drugs and doses for concomitant and sequential chemotherapy. For sequential chemotherapy, all trials used at last cisplatin, induction chemotherapy was used in five trials, and consolidation in one.
For concomitant chemotherapy, cisplatin was used in five trials and carboplatin in one trial. One trial used consolidation chemotherapy after concomitant chemotherapy.