Palliative chemoradiation boosts survival, QoL in poor-prognosis NSCLC

Oct 10 2013

By Joanna Lyford, Senior medwireNews Reporter

C hemoradiation is superior to chemotherapy alone with respect to both survival and quality of life (QoL) in patients with inoperable non-small-cell lung cancer (NSCLC), a phase III trial has found.

The benefit of palliative chemoradiation was restricted to patients with negative prognostic factors and was at the expense of more hospital admissions for treatment-related toxicity.

“PS [performance status] 2 patients had no survival benefit and should receive chemotherapy alone,” remark Hans Henrik Strøm (University of Tromsø, Norway) and co-authors, writing in the British Journal of Cancer.

The study was undertaken to assess the role of chemoradiation in patients with stage III locally advanced, inoperable NSCLC. A total of 191 patients were enrolled; none were eligible for curative radiotherapy, the median age was 67 years, and 79% had a PS of 0 or 1.

Importantly, all patients had at least one negative prognostic factor, such as tumor size of 8 cm or more, PS of 2 or more, or weight loss of more than 10% in the past 6 months.

Patients were randomly assigned to receive chemotherapy (four cycles of carboplatin on day 1 and oral vinorelbin on days 1 and 8 every 21 days) either alone or with radiotherapy (42 Gy/15 fractions) starting on the second cycle of chemotherapy.

Median overall survival was significantly longer with chemoradiation than with chemotherapy alone, at 12.6 versus 9.7 months, as was 1-year survival, at 53.2% versus 34.0%.

With regard to secondary endpoints, health-related (HR) QoL declined significantly during chemoradiation but returned to near-baseline levels after treatment had ended. By contrast, HRQoL decreased significantly during chemotherapy and remained low after the end of treatment.

Toxicity was significantly more frequent in the chemoradiation group, with more episodes of esophagitis and more hospital admissions; however, there were no differences between groups in the frequency of bleeding, thrombocytopenia, or number of platelet transfusions.

Strøm and co-authors conclude that concurrent chemoradiation is superior to chemotherapy alone in patients with locally advanced stage III NSCLC and poor prognostic factors.

“Future trials to establish the best concurrent chemoradiotherapy regimen (radiation dose/fractionation, volume, planning, and new systemic therapies) are required to provide further information regarding the optimal treatment for this challenging patient population,” they write.

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