A critical review of recent developments in radiotherapy for non-small cell lung cancer

Radiation Oncology

Table 2 Outcomes from randomized trials with a surgical arm in stage III non-small cell lung cancer

Trial	Inclusion	Staging PET or PET/CT	Study question	RT^a	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 0139^b [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 %
ESPATUE^c [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 %

Courtesy of Prof. Rafal Dziadziuszko. Discussant ESMO 2014 Madrid. Modified to update subsequent publication
CT induction chemotherapy, CRT concurrent chemoradiotherapy, RT radiotherapy; S surgery, CRTboost concurrent chemoradiotherapy boost, RP radiation pneumonitis, NR not reported, BID twice daily, OS overall survival
^aRT doses in standard fractionation unless otherwise indicated
^bIncreased disease-free survival in surgery arm (12.8 vs 10.5 months; p = 0.017); unplanned analysis showed longer median OS in lobectomy subgroup vs matched CRT subgroup (33.6 vs 21.7 months; p = 0.002)
^c246 enrolled (out of 500 planned). After induction treatment, patients with resectable tumors (n = 161, 65 %) randomized. In all 246 patients, 5 year OS 34 %

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