Chemotherapy plus radiotherapy for small-cell lung cancer

Dr Kathy Albain, Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL, USA, and colleagues.Dr Kathy published an online first article discussed about radiotherapy plus chemotherapy, with or without surgery, are both treatment options for patients with stage IIIA (N2) non-small cell lung cancer (NSCLC) where in an upcoming edition of The Lancet and published in 16, July.

NSCL make up about 80% of lung cancers, it’s due to most common long-term exposure to tobacco smoke. Based on an authors comment. Where lung cancer treatment front-line surgery can’t effectively cure the disease because it has already spread to lymph nodes in the centre of the chest (N2). the authors compared concurrent chemotherapy and radiotherapy followed by surgery with standard concurrent chemotherapy and radiotherapy without surgery, the current standard for this group patients

The scientist randomly assigned patients with stage IIIA (N2) NSCLC to concurrent induction chemotherapy (two cycles of cisplatin [50 mg/m² on days 1, 8, 29, and 36] and etoposide [50 mg/m² on days 1-5 and 29-33]) plus radiotherapy (45 Gy) in multiple academic and community hospitals.

The scientist found no progression, patients in group 1 underwent surgery and those in group 2 continued radiotherapy uninterrupted up to 61 Gy. Two additional cycles of cisplatin and etoposide were given in both groups.  

 Among 202 patients (median age 59 years, range 31-77) were assigned to Group 1 and 194 (61 years, 32-78) to Group 2. The authors noted that the end result was overall survival.

According the scientist finding that the number of patients survive at five years was 37 in Group One and 24 in Group Two. Progression free survival seemed better in Group One than in Group Two, median 12.8 months versus 10.5 months; the number of patients without disease progression at five years was 32 (Group One) versus 13 (Group Two).

Based on the scientist comment that esophagitis and lower white blood cell counts  were the main grade three or four toxicities associated with radiotherapy plus chemotherapy  in Group One (38 percent and 10 percent, respectively) and Group Two (41 percent and 23 percent, respectively). In Group One, 8 percent deaths were treatment related versus 2 percent Group Two. In an exploratory analysis, overall survival was getting a positive result for patients who underwentlobectomy,   chemotherapy plus radiotherapy.

"Chemotherapy plus radiotherapy with or without resection (preferably lobectomy) are options for patients with stage IIIA (N2) non-small-cell lung cancer... medically healthy patients with stage IIIA (N2) non-small-cell lung cancer should be assessed by a team skilled in multimodality treatment, and treatment options can be considered during assessment," the authors wrote. "On the basis of the findings of our study, patients should be counseled about the risks and potential benefits of definitive chemotherapy plus radiotherapy with and without a surgical resection (preferably by lobectomy)."

Source: The Lancet, Medical News.