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 % |