Phase III Study of Concurrent versus Sequential Thoracic Radiotherapy in Combination with Mitomycin, Vindesine, and Cisplatin in Unresectable Stage III Non-Small-Cell Lung cancer

Reviewers: Li Liu, MD
Source: Journal of Clinical Oncology, 17(9): 2692, September 1999

Background

This is a long-term follow-up of a landmark study by the West Japan Lung Cancer Group (WJLCG) directly comparing concurrent chemoradiation to sequential chemoradiation for patients with unresectable stage III non-small-cell lung cancer (NSCLC). Patients in both arms of the study received two courses of MVP (Cisplatin, Vindesine, andMitomycin) and 56Gy of thoracic radiotherapy. The radiotherapy was delivered as a continuous course in the sequential arm of the trial but as a split-course in the concurrent arm with a 10-day break after the first 28Gy.

• The overall response rates were high: 84% for concomitant treatment and 66.4% for sequential treatment (p=0.0002). This could be due in part to the follow up policy of weekly chest x-rays (CXR) to assess response and CT scans if disease was not measurable by CXR.
• Median survival durations were 16.5 months for patients given concomitant treatment and 13.3 months for those who received sequential treatment (p=0.03998).
• The survival advantage persisted at 5 years, 15.8% in the concurrent group Vs 8.9% in the sequential group with 11 and 7 evaluable patients respectively. Myelosuppression was more significant in the concurrent group but was manageable.

Discussion

The Radiation Therapy Oncology Group (RTOG) is expected to report a 3-arm study comparing concurrent conventionally fractionated chemoradiation Vs concurrent hyperfractionated chemoradiation Vs sequential chemoradiation in the year 2000. In this trial, the thoracic radiotherapy dose was 63Gy in a continuous course and chemotherapy was cisplatin/vinblastine. This regimen is considered more conventional by US standards.

From the conclusions of these two trials, hopefully we will be able to reach a consensus regarding optimal treatment for selected patients with unresectable stage III NSCLC.