Comparison of concurrent chemo-radiotherapy and sequential chemo-radiotherapy for locally advanced non-small cell lung cancer

Objective: Prospective comparison was done on concurrent chemo-radiotherapy and sequential chemo-radiotherapy for unresectable stage III non-small cell lung cancer (NSCLC) and to evaluate three different regimens of concurrent chemo-radiotherapy. Methods: Ninety-six such patients were randomized into four groups: 1. sequential chemo-radiotherapy group received two cycles of induction chemotherapy with 40 mg/m2 of cisplatin on D 1-3, 29-31 and 100 mg/m2 of etoposide on D 1-3, 29-31 before conventional radiotherapy, 2. concurrent chemo-radiotherapy group 1 received 100 mg/m2 etoposide on D 1-3 and DDP 40 mg/m2 on D 1-3, D 29-31, iv. drip, 3. concurrent chemo-radiotherapy group 2 received concurrent chemotherapy with 40 mg/m2 of paclitaxel every Monday during conventional radiotherapy, 4. concurrent chemo-radiotherapy group 3 received concurrent chemotherapy with 40 mg/m2 of paclitaxel every Monday during three-dimensional conformal radiotherapy. All patients were irradiated with 2.0 Gy/fraction, 5 fractions/week, to a total dose of 60 -64 Gy. They all received two cycles of consolidation themotherapy with 40 mg/m2 of cisplatin on D 1-3 and 100 mg/m2 of etoposide on D 1-3. Results: The overall response rate was 67%, 71%, 71% and 79% for sequential chemo-radiotherapy group, concurrent chemo-radiotherapy group 1, 2 and 3, respectively. There was a significant difference between the concurrent chemo-radiotherapy and sequential chemo-radiotherapy(P0.05) also was the difference of toxicity (P>0.05), but the severe toxicity of concurrent chemo-radiotherapy groups 1 and 2 were higher than the sequential chemo-radio-therapy group and concurrent chemo-radiotherapy group 3. Conclusions: Better locoregional progression-free survival and overall survival of unresectable stage III non-small cell lung cancer could be achieved by concurrent chemo-radiotherapy as compared with sequential chemo-radiotherapy though at the expense of in- crease in toxicity. With the combination of concurrent chemo-radiotherapy and conformal radiotherapy, the o- verall survival rate could be much improved with miider toxicity. (authors)