Table 2 Outcomes from randomized trials with a surgical arm in stage III non-small cell lung cancer
From: A critical review of recent developments in radiotherapy for non-small cell lung cancer
| Trial | Inclusion | Staging PET or PET/CT | Study question | RTa | Chemotherapy | N (randomized) | Answer | Treatment related mortality | 5-year OS |
|---|---|---|---|---|---|---|---|---|---|
| EORTC 08941 [125] | Unresectable IIIA (N2) | Not mandatory | CT-S vs CT-RT | 60–62.5 Gy to primary and involved mediastinum; 40–46 Gy to uninvolved mediastinum | Platinum-based with at least one other agent | 332 | No significant difference |
4 % within 30 days of surgery 1 patient died of RP, timing NR |
16 % 14 % |
| INT 0139b [126] | Potentially resectable IIIA (N2) | Not mandatory | CRT-S vs CRT |
45 Gy in CRT-S arm 61 Gy in CRT arm | Cisplatin-etoposide | 429 (396 eligible) | No significant difference |
8 % 2 % (No deaths during induction) |
27 % 20 % |
| ESPATUEc [127] | Resectable IIIA (N2) and selected IIIB | 97 % | CT-CRT-S vs CT-CRT-CRTboost |
Both arms: induction 45 Gy delivered as 1.5 Gy BID In definitive CRT arm: risk-adapted CRTboost to 65–71 Gy |
Induction: cisplatin-paclitaxel Concurrent: cisplatin-vinorelbine | 161 | No significant difference, but closed early and was under- powered with respect to the primary end-point of OS |
6 % in surgical arm 3 % in definitive CRT arm (2 additional patients died during induction) |
44 % 40 % |
| SAKK 16/00 [128] | Resectable IIIA (N2) | Required (rate NR) | CT-RT-S vs CT-S | 44 Gy (in 22 fractions over 3 weeks) | Cisplatin-docetaxel | 232 | No difference |
0 % within 30 days of surgery 3 % within 30 days of surgery |
40 % 34 % |