Preop or postop radiation, both effective in advanced NSCLC

[Alisa]

Preop or postop radiation, both effective in advanced NSCLC

"Whether radiation is given to patients with advanced non-small cell lung cancer (NSCLC) before chemotherapy and surgery or after is equally as effective, according to a study presented here at the American Society for Therapeutic Radiology and Oncology's 46th Annual Meeting."

http://www.hemonctoday.com/200411/frame ... =preop.asp

[Hebbie]

That sounds very encouraging, and I would love to read the article, but it wants a log on....

Any chance that we can get the article posted in here?

[Alisa]

November 2004

ATLANTA — Whether radiation is given to patients with advanced non-small cell lung cancer (NSCLC) before chemotherapy and surgery or after is equally as effective, according to a study presented here at the American Society for Therapeutic Radiology and Oncology’s 46th Annual Meeting.

“Neither of the treatment regimens have a clear advantage over the other,” said Christian Ruebe, MD, a radiation oncologist at Saarland University in Hamburg.

Radiation timing

Advanced NSCLC continues to be a difficult disease to treat effectively. Ruebe and his colleagues wanted to evaluate whether the placement of radiation in a multitherapy regimen made a difference in outcomes.

The researchers randomized 525 patients with stage-3 NSCLC to one of two treatment arms. In arm A, patients received three cycles of cisplatin and etoposide. This was followed by hyperfractionated radiotherapy at a total dose of 45 Gy with concurrent carboplatin (Paraplatin, Bristol-Myers Squibb) and vindesine (Eldisine, Lilly in Europe). Patients then went on to surgery. If there was no resection, or an R1 or R2-grade resection, they received an additional 24 Gy of hyperfractionated radiation.

“Neither of the treatment regimens have a clear advantage over the other.”

— Christian Ruebe, MD

In arm B, patients received three cycles of cisplatin and etoposide before surgery. After surgery, the received 54 Gy or 68.4 Gy of hyperfractionated radiation if resection was not possible or of an R1 or R2 grade.

The overall results of the treatments were good, according to a press release from the meeting.

After a median follow-up of 52 months, the three-year overall-survival rates were 26.2% for patients in arm A and 24.6% for patients in arm B. The three-year progression-free survival rates were 17.8% and 19.9% in arms A and B, respectively.

Differences in overall and progression-free survival were not significant, according to the study.

There was also no difference in the rates of complete or partial remission or unsuccessful resection. The median overall and progression-free survivals were also similar between treatment arms.

The similarities persisted when researchers stratified patients by stage-3a or stage-3b disease.

Toxicity concerns remained for both treatments, although there were some differences in the frequency of severe toxicities between the treatment arms. The incidence of grade-3/4 esophagites was more frequent in arm A, occurring in 19% of patients, compared with 3% in arm B. Grade-3/4 pneumonitis occurred in 6% of patients in arm B, significantly higher than the 1% in arm A.

Ruebe noted, however, that there was no difference in treatment-related mortality.

For more information:

Ruebe C, Risenbeck D, Semik M, et al. Neoadjuvant chemotherapy followed by preoperative radiochemotherapy (hfRCT) plus surgery or surgery post postoperative radiotherapy in stage III non-small cell lung cancer: results of a randomized phase III trial of the German Lung Cancer Cooperative Group. Abstract #1. Presented at the American Society for Therapeutic Radiology and Oncology’s 46th Annual Meeting. Oct. 3-7, 2004. Atlanta.