HOUSTONPretreatment with induction chemotherapy appears to give certain inoperable non-small-cell lung cancer (NSCLC) patients who undergo radiation and concurrent chemotherapy (chemoradiation) a small but statistically significant increase in overall, 5-year, and distant-metastasis-free survival, compared with concurrent chemoradiation alone, the standard of care.
The findings emerged from a retrospective analysis of NSCLC patients treated at The University of Texas M.D. Anderson Cancer Center.
"The results of this study suggest that adding two or three cycles of induction chemotherapy may improve overall survival by reducing distant metastases without compromising local control," the authors reported in the July 1 issue of the International Journal of Radiation Oncology•Biology•Physics (68:779-785, 2007). "Our results for patients treated with concurrent chemoradiation alone were similar to those from the two randomized trials that established this approach as the standard of care."
265 Consecutive Patients
In their study, radiation oncologist Eugene H. Huang, MD, and his colleagues included 265 consecutive NSCLC patients treated with three-dimensional conformal radiation and concurrent chemotherapy, including 127 patients (48%) who received two or three cycles of induction chemotherapy using a dual-agent regimen prior to chemoradiation.
The induction group included 121 patients who received a platinum and taxane; the remaining 6 pretreated patients received cisplatin/etoposide, cisplatin/gemcitabine (Gemzar), or gemcitabine/vinorelbine (Navelbine).
The two groups did not differ with respect to age, weight loss, performance status, histology, grade, combined stage, T stage, N stage, or mediastinoscopic staging, Dr. Huang said.
The radiotherapy typically targeted the gross tumor volume and the involved lymph node stations in both patient groups with daily 1.8- or 2-Gy fractions (183 patients) or twice daily 1.2-Gy fractions (82 patients). Uninvolved lymph nodes were not irradiated.