The benefit of treatment intensification is age and histology-dependent inpatients with locally advanced nonsmall cell lung cancer (NSCLC): A quality-adjusted survival analysis of radiation therapy oncology group (RTOG) chemoradiation studies

Purpose: Currently, chemoradiation treatment strategies in locally advanced NSCLC are essentially the same irrespective of tumor histology or patient age. The purpose of this study is to analyze the impact of age, histology, Karnofsky performance status (KPS), and specific toxicities on the median s urvival time (MST) and quality-adjusted survival (QTime) for each treatment strategy. Methods and Materials: Nine hundred seventy-nine patients with Stage II-III B inoperable NSCLC were enrolled on 6 prospective Phase II and III studies from 1983 to 1995. Treatment regimens ranged from standard RT (SRT) to 60 G y, hyperfractionated RT (HRT) to 69.6 Gy, induction chemotherapy (ICT) of c isplatin (CTS) and vinblastine (VBL) followed by SRT, ICT + concurrent CT ( CCT) + SRT, and CCT + HRT; CCT consisted of etoposide or VBL + CIS. Toxicit ies assessed were skin, mucous membrane, lung, esophagus, neurologic, hemat ologic, and upper GI. QTime was calculated by weighting the time spent with a specific toxicity, as well as local or distant tumor progression. Each t oxicity was weighted with increasing severity as the toxicity increased in grade. Results: As expected, patients with the worst KPS (50-70) had the lowest MS T (7.8 months) and QTime (6.7 months). Patients < 70 years had improved sur vival with more aggressive therapy (i.e., ICT + SRT or CCT + HRT), while pa tients > 70 years achieved the best QTime with standard RT (SRT) alone. In patients with squamous cell carcinoma, those treated with ICT + CCT + SRT h ad dramatically improved MST (25.7 months) and QTime (21.8 months) compared to the other treatment regimens (11.7-12.8 and 10.7-12 months, respectivel y). Patients with adenocarcinoma, however, generally manifested incremental ly better MST and QTime as the therapies intensified. Within the concurrent chemoradiation arms, the upper GI and lung toxicities had the greatest imp act on QTime. Conclusion: This quality-adjusted survival analysis suggests that there is a critical relationship between the type of histology and its optimal treat ment, age and the ability to tolerate intensive therapy, and the need to re duce lung and upper GI toxicities. (C) 1999 Elsevier Science Inc.