Concurrent radiation, chemo, followed by surgery lengthens lung cancer patients' survival

May 18 2005

Patients whose lung cancer has spread to the lymph nodes have a better chance of long-term survival if they receive combined modality therapy, such as concurrent radiation and chemotherapy followed by surgery, according to a study that Loyola University Health System’s Dr. Kathy S. Albain presented at the American Society of Clinical Oncology annual meeting.

“For patients whose lung cancer can be removed by just taking out a portion of the lung, surgery following combined chemotherapy and radiation is the best approach,” said lead investigator Albain, professor, division of hematology/oncology, department of medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Ill.

“If the whole lung needs to be removed, surgery may be too risky and for these patients, the best option is the combination of chemotherapy plus radiation,” said Albain, who also is director, thoracic oncology program; director, breast clinical research program; and co-director of the multidisciplinary breast oncology center, Cardinal Bernardin Cancer Center, Loyola University Health System, Maywood, Ill.

These study results are the five-year outcomes update of the National Cancer Institute-sponsored North American Lung Intergroup trial 0139. Albain serves as the medical oncology study chair for the landmark Phase III trial, the only study of its kind in the world.

Participating in the study were 396 patients with stage IIIA N2 non-small cell lung cancer (NSCLC). Researchers divided the patients into two groups: the first group (194 patients) received concurrent chemotherapy and radiation. The second group (202 patients) received a regimen of chemotherapy and radiation followed by surgery.

Lung cancer is the leading cause of cancer deaths in men and women. NSCLC accounts for 87 percent of all diagnoses of lung cancer.

To be eligible for the study, patients had to be generally medically fit and meet specific respiratory function criteria.

“At five-year follow-up, 27 percent of patients who received chemotherapy and radiation followed by surgery are alive compared to 20 percent of patients who had chemotherapy and radiation only,” said Albain. “In addition, significantly fewer patients in the chemotherapy/radiation/surgery group have a recurrence of their cancer.”

Participants in the chemotherapy/radiation/surgery group remained cancer-free for a median of 12.8 months compared to 10.5 months among those in the chemotherapy/radiation group. Living cancer-free were 22 percent of patients treated with chemotherapy/radiation/surgery and 11 percent of patients treated without surgery.

“For those patients able to have only a part of their lung removed after undergoing chemotherapy and radiation, five-year survival was 36 percent compared to five-year survival of 18 percent for similar patients who underwent chemotherapy and radiation only,” said Albain. “Patients with non-small cell lung cancer whose cancer is locally advanced have two options to consider that offer a better chance of survival than would be the case after surgery or radiation alone.”

Albain said that lung cancer patients need to be seen at medical centers where an entire team of all disciplines is involved in treatment decisions. Included on the team should be a medical oncologist, radiation oncologist and thoracic surgeon, she said.