Many clinicians have been debating the best way to treat advanced lung cancer. The question has been whether or not to give chemotherapy and/or radiation alone, before or after surgery.
The largest observational study of its kind has offered some impressive evidence.
This new study found that stage III (advanced) non-small cell lung cancer (NSCLC) patients who received a combination of chemotherapy and radiation before surgery lived longer than patients who received only chemoradiation.
Patients who had the neoadjuvant (before surgery) therapy were twice as likely to be alive after five years as people who had chemoradiation alone.
Matthew Koshy, MD, a radiation oncologist at the University of Illinois Hospital & Health Sciences System, led the study which involved 11,242 patients who were treated for stage III NSCLC between 1984 and 2004.
The purpose of this study was to examine whether neoadjuvant chemoradiation was associated with improved survival.
There are currently three treatment options for advanced NSCLC: chemoradiation therapy alone, surgery followed by chemoradiation and chemoradiation before surgery.
"The role of chemoradiation therapy followed by surgery is somewhat controversial, because previous clinical studies have not shown a clear survival benefit," Dr. Koshy said in a press release announcing the study findings.
In this study, researchers evaluated which patients were alive five years after treatment. They found the following:
- 34 percent of patients who received chemoradiation therapy followed by surgery to remove a lobe of the lung (lobectomy) were alive after five years.
- 20 percent of patients who had the surgery followed by the adjuvant (after surgery) therapy reached the five-year mark.
- 13 percent of patients who received chemoradiation therapy but no surgery were still alive at five years.
Ross Camidge, MD, PhD, the director of the lung cancer clinical program at the University of Colorado Hospital in Aurora, told dailyRx News, “This is an interesting and thought-provoking study. Perhaps the most intriguing observation is that neoadjuvant chemoradiation followed by surgery seemed to do better than the equivalent surgery with adjuvant chemotherapy, where, if anything, radiation would be expected to bias towards poorer prognosis patients. Choosing the right patient is going to be key, but this study lends support to the use of neoadjuvant chemoradiation in some patients, consistent with the subgroup analyses of major prospective studies,” Dr. Camidge said.
“This study also highlights the importance of patients with locally advanced lung cancer to be initially evaluated in a multidisciplinary setting with a thoracic surgeon, medical oncologist, and radiation oncologist, to determine the most appropriate initial treatment strategy,” the authors concluded.
The study was published in the May issue of the Journal of Thoracic Oncology.
The study was conducted in partnership with the University of Chicago and the American Cancer Society, which provided the funding for the research. No conflicts of interest were disclosed.