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Table 3 Outcomes with definitive chemoradiotherapy for 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-CT Histology Treatment regimen in standard CRT arma RT technique N PTV (mean) Toxicity in standard CRT arm Outcomes
RTOG 0617 [58] Unresectable III 91 % 42/47 % squamous in 60/74 Gy arms 60 Gy
Concurrent carboplatin-paclitaxel, followed by 2 cycles consolidation
46/47 % IMRT in 60/74 Gy arms
(Remainder 3DCRT)
424 analyzable for radiation end-point 495/510 mL in the 60/74 Gy arm In 60 Gy arm:
Grade ≥ 3 RP 7 %
Grade ≥ 3 esophagitis 7 %
Grade 5 toxicity 3 %
In 60 Gy arm:
Median OS 29 months
2-year OS 58 %
2-year LF 31 %
2-year DF 47 %
PROCLAIM [78] Nonsquamous III 82 % Non-squamous only 60–66 Gy
Arm A: pemetrexed-cisplatin, pemetrexed consolidation
Arm B: etoposide-cisplatin, non-pemetrexed consolidation
25 % IMRT
(Remainder 3DCRT)
598 607/585 mL Grade ≥ 3 RP 1.8/2.6 %
Grade ≥ 3 esophagitis
15.5/20.6 %
Grade 5 toxicity 1.7/1 %
Median OS 27/25 months
Median PFS 11.4/9.8 months
IFF (site of 1st failure) 42 %
DF (site of 1st failure) 48 %
KCSG-LU05-04 [79] Unresectable III 92 % 32 % squamous 66 Gy
Concurrent docetaxel-cisplatin
Arm A: CRT-observation
Arm B: CRT-docetaxel-cisplatin consolidation
NR 437 eligible NR Grade ≥ 3 RP 1.2 %
Grade ≥ 3 esophagitis
9.5 %
Grade 5 toxicity 3.6 % during CRT, 2.9 % during consolidation
Median OS 20.6/21.8 months
Median PFS 8.1/9.1 months
After median follow-up time of 51 months:
DF 25 %
LRR 25 %
DF and LF 3 %
RTOG 9410 [129] Inoperable stage II-III 0 % 38 % squamous 63 Gy
Cisplatin-Vinblastine
2DRT 610 N/A For CRT with early RT arm:
Grade ≥ 3 esophagitis 22 %
Grade ≥ 3 acute RP 4 %
Grade 5 toxicity 2 % (as worst overall toxicity)
For CRT with early RT arm:
5-year OS 16 %
Median OS 17 months
IFF only 25 %
Out of field only 37 %
Both IFF and out of field 10 %
Meta-analysis of 6 trials comparing CRT vs sequential CT/RT [130] Unresected stage III 0 % 46 % 60 Gy (2 trials), 66 Gy, (1 trial), 66 Gy in 24 fractions (1 trial), 56 Gy split course (1 trial), 48.5 Gy (split course of 36 Gy in 12 fractions, 7 days rest, 12.5 Gy in 5 fractions)
Single agent low-dose cisplatin (2 trials), cisplatin-based doublet (3 trials), carboplatin (1 trials)
3DCRT in 1 trial
Remainder 2DRT
603/602 in concurrent/sequential groups N/A Grade ≥ 3 esophagitis 18 % (concurrent CRT)
Rates of acute RP and Grade 5 toxicity NR
For concurrent CRT patients:
3-year OS 24 %
5-year OS 15 %
3-year LRF 28 %
5-year LRF 29 %
3-year DF 40 %
5-year DF 41 %
  1. Abbreviations CRT chemoradiotherapy, CT chemotherapy, RT radiotherapy, IMRT intensity modulated radiotherapy, PTV planning target volume, mL milliliters, N/A not applicable, RP radiation pneumonitis, OS overall survival, DFS disease free survival, IFF in-field failure, LF local failure, DF distant failure, LRR locoregional recurrence, NR not reported, 3DCRT three- dimensional conformal radiotherapy, 2DRT two-dimensional radiotherapy
  2. aAll RT standard fractionation