Peri-Operative Chemo-Radio-Therapy Versus Radiotherapy Alone in NSC-Lung Cancer

Background: In patients with unresectable non-small cell lung cancer, a short course of cisplatin and vinblastine prior to radiation significantly improves median survival and doubles the number of long-term survivors, as compared with radiation therapy alone. A randomized prospective study using radio-therapy with or without concomitant chemotherapy in patients who have undergone resection as well as initial chemotherapy for those with marginally resectable disease. The goals are to assess the feasibility and reproducibility of the combined regimen and to evaluate its ability to improve local control and survival. Methods: Forty two patients (30 men, 12 women) had stage II or IIIA disease. Their median age was 54 years (range 33-63years). All had experienced no significant weight loss. Group A (21 patients): Patients with marginally resectable disease received two cycles of chemotherapy pre-operatively and a maximum of four cycles post-operatively. Patients with initially resectable tumors received four cycles postoperatively. Radiation therapy was begun on day 1 or 2 concomitantly with chemotherapy. Group B (21 patients) received radiotherapy alone. Results: During chemo-radiotherapy two patients developed toxicity and were shifted to group B. Eighteen out of 19 remained alive at the end of chemo-radio-therapy and recorded median survival of 51.3 months compared with 16 out of 23 in group B who had median survival of 42.9 months (p=0.001). Conclusion: Concomitant chemo-radio-therapy is feasible and reproducible as adjuvant treatment in non small-cell lung cancer.