Performing surgery following concurrent chemotherapy and radiotherapy for patients with stage IIIA (N2) non-small cell lung cancer does not lead to better overall survival rates than chemotherapy and radiation therapy alone, according to a landmark Radiation Therapy Oncology Group study (RTOG 9309) published online July 25 in the Lancet.
Non-small cell lung cancer represents approximately 80% of all types of lung cancer. Its most common cause is long-term exposure to tobacco smoke.
The study determined that surgery following chemotherapy and radiation therapy produced better progression-free survival rates for patients who had surgical resection of a single lung lobe, rather than the entire lung. For these patients, all three treatments may yield a superior outcome in delay relapse and improved survival, according to the study's principal investigator, Dr. Kathy Albain of Loyola University in Maywood, IL.
In the study, one patient cohort (n = 194) received concurrent chemotherapy and radiation therapy without surgery, the current standard for treatment of stage IIIA (N2) non-small cell lung cancer. The patients were compared with those in another group (n = 220) who received concurrent chemotherapy and radiation therapy followed by surgery.
All patients received 45 Gy of radiation therapy and concurrent induction chemotherapy (receiving cisplatin and etoposide). Patients who showed no progression in the first group underwent surgery, and those in the second group continued to receive uninterrupted radiation therapy treatment to 61 Gy. Both groups received two additional cycles of chemotherapy.
Comparison of outcomes statistics
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In an exploratory analysis, overall survival was improved for patients who underwent a lobectomy but not pneumonectomy, versus chemotherapy plus radiation therapy.
While the reason for an absence of effect of surgery could be inadequate power in the trial or reduced delivery of later chemotherapy (cycles three and four) in the surgery group, the researchers believe that increased mortality following pneumonectomy was mainly due to acute respiratory distress syndrome and other respiratory causes.
Related Reading
New lung cancer staging guidelines reflect improved CT, survival data, June 1, 2009
Radiotherapy may be preferable to surgery after chemotherapy for lung cancer, March 21, 2007
Benefits of surgery for non-small cell lung cancer unclear, July 10, 2006
Concurrent/consolidation regime provides best survival for stage III lung cancer, October 5, 2005
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