Induction chemotherapy plus three-dimensional conformal radiation therapy in the definitive treatment of locally advanced non-small-cell lung cancer

Purpose: To evaluate our institution's experience using chemotherapy in con junction with three-dimensional conformal radiation therapy (3D-CRT). Methods and Materials: From 1991 to 1998, 152 patients with Stage III non-s mall-cell lung cancer (NSCLC) were treated with 3D-CRT at Memorial Sloan-Ke ttering Cancer Center. A total of 137 patients (90%) were surgically staged with either thoracotomy or mediastinoscopy. The remainder were staged radi ographically. Seventy patients were treated with radiation therapy alone, a nd 82 patients received induction chemotherapy before radiation. The majori ty of chemotherapy-treated patients received a platinum-containing regimen. Radiation was delivered with a 3D conformal technique using CT-based treat ment planning. The median dose in the radiation alone group was 70.2 Gy, wh ile in the combined modality group, it was 64.8 Gy. Results: The median follow-up time was 30.5 months among survivors. Stage I IIB disease was present in 36 patients (51%) in the radiation-alone group a nd 57 patients (70%) in the combined-modality group. Thirty-nine patients h ad poor prognostic factors (KPS < 70 or weight loss > 5%), and they were eq ually distributed between the two groups. The median survival times for the radiation-alone and the combined-modality groups were 11.7 months and 18.1 months, respectively (p = 0.001). The 2-year rates of local control in the radiation-alone and combined-modality groups were 35.4% and 43.1%, respect ively (p = 0.1). Grade 3 or worse nonhematologic toxicity occurred in 20% o f the patients receiving radiation alone and in 16% of those receiving chem otherapy and radiation. Overall, there were only 4 cases of Grade 3 or wors e esophagitis. Conclusion: Despite more Stage M patients in the combined-modality group, t he addition of chemotherapy to 3D-CRT produced a survival advantage over 3D -CRT alone in Stage III NSCLC without a concomitant increase in toxicity. C hemotherapy thus appears to be beneficial, even in patients who are receivi ng higher doses of radiation therapy than are typically given with conventi onal techniques. Because locoregional failure remains a major challenge in patients with advanced disease, 3D-CRT in conjunction with chemotherapy may allow safe treatment to the dose levels required to further enhance local control. (C) 2001 Elsevier Science Inc.