INDUCTION CHEMOTHERAPY PLUS HIGH-DOSE RADIOTHERAPY VERSUS RADIOTHERAPY ALONE IN LOCALLY ADVANCED UNRESECTABLE NON-SMALL-CELL LUNG-CANCER

Background: High-dose radiation therapy is generally recommended as st andard treatment in regionally advanced unresectable non-small-cell lu ng cancer (NSCLC), but median-and long-term survival remain poor. Some reports have recently shown an improvement of results in advanced NSC LC when cisplatin was included in the chemotherapy regimens. Therefore , we designed a randomized trial to determine whether induction chemot herapy before high-dose radiotherapy improves response rate and surviv al in stage III NSCLC over that achieved with radiotherapy alone. Pati ents and methods: From March, 1984 to December, 1988, 66 consecutive p atients with stage III unresectable NSCLC were randomized to one of tw o treatment arms; 61 were evaluable for survival and 58 for response a nd toxicity. Patients randomly assigned to arm A received cisplatin (C DDP 100 mg/m(2) on day 1) and etoposide (Vp 16 120 mg/ m(2) on days 1, 2, 3) every 3 wks for 3 courses followed by radiotherapy 56 Gy on pre -treatment tumor volume and 40 Gy on mediastinum and bilateral supracl avicular nodes. Patients assigned to arm B received only the same radi otherapy. The 61 eligible patients were comparable in terms of age, pe rformance status, histology and treatment. Results: Response rate was 53% in arm A and 32% in arm B. The median survival was 52 wks for the combined treatment arm and 36 wks for the radiation therapy arm. At si x years of follow-up all the patients were dead. Toxicity was mild and no treament-related deaths were recorded. Conclusion: Induction chemo therapy produced a better response rate and a trend of improved surviv al (4 months) but a significant survival advantage was not achieved (p < 0.11), probably because of the small number of patients enrolled in the trial.