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A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903).
- Source :
-
Cancer [Cancer] 2012 Dec 15; Vol. 118 (24), pp. 6126-35. Date of Electronic Publication: 2012 Jun 06. - Publication Year :
- 2012
-
Abstract
- Background: This study sought to ascertain whether induction-concurrent radiotherapy added to chemotherapy could improve the survival of patients undergoing surgery for stage IIIA N2 nonsmall cell lung cancer (NSCLC).<br />Methods: Patients with pathologically proven N2 disease were randomized to receive either induction chemotherapy (docetaxel 60 mg/m(2) and carboplatin AUC [area under the receiver operating characteristic curve] = 5 for 2 cycles) plus concurrent radiation therapy (40 Gy) followed by surgery (CRS arm) or induction chemotherapy followed by surgery (CS arm). They subsequently underwent pulmonary resection when possible.<br />Results: Sixty patients were randomly assigned between December 2000 and August 2005. The study was prematurely terminated in January 2006 because of slow accrual. The most common toxicity was grade 3 or 4 leukopenia in 92.9% of patients in the CRS arm and 46.4% in the CS arm. Induction therapy was generally well tolerated, and there were no treatment-related deaths in either arm. Downstaging in the CS arm and CRS arm was 21% and 40%, respectively. The progression-free survival (PFS) and overall survival (OS) in the CS arm were 9.7 months and 29.9 months (PFS, hazard ratio [HR] = 0.68, P = .187), and those in the CRS arm were 12.4 months and 39.6 months (OS, HR = 0.77, P = .397), respectively. The PFS with and without downstaging was 55.0 and 9.4 months, respectively (HR = 3.39, P = .001). The OS with and without downstaging was 63.3 and 29.5 months, respectively (HR = 2.62, P = .021).<br />Conclusions: The addition of radiotherapy to induction chemotherapy conferred better local control without significant adverse events. Tumor downstaging is important for prolonging the OS in patients with stage IIIA (N2) NSCLC.<br /> (Copyright © 2012 American Cancer Society.)
- Subjects :
- Adenocarcinoma mortality
Adenocarcinoma secondary
Adult
Aged
Carboplatin administration & dosage
Carcinoma, Non-Small-Cell Lung mortality
Carcinoma, Non-Small-Cell Lung secondary
Carcinoma, Squamous Cell mortality
Carcinoma, Squamous Cell secondary
Docetaxel
Female
Follow-Up Studies
Humans
Lung Neoplasms mortality
Lung Neoplasms pathology
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Recurrence, Local mortality
Neoplasm Recurrence, Local pathology
Neoplasm Recurrence, Local therapy
Neoplasm Staging
Prognosis
Remission Induction
Survival Rate
Taxoids administration & dosage
Adenocarcinoma therapy
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Carcinoma, Non-Small-Cell Lung therapy
Carcinoma, Squamous Cell therapy
Chemoradiotherapy
Lung Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1097-0142
- Volume :
- 118
- Issue :
- 24
- Database :
- MEDLINE
- Journal :
- Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 22674529
- Full Text :
- https://doi.org/10.1002/cncr.26689