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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 %
  1. Courtesy of Prof. Rafal Dziadziuszko. Discussant ESMO 2014 Madrid. Modified to update subsequent publication
  2. 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
  3. aRT doses in standard fractionation unless otherwise indicated
  4. 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)
  5. 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 %