Neoadjuvant radiotherapy improves lung cancer survival
MedWire News: Patients with locally advanced nonsmall-cell lung cancer (NSCLC) who receive neoadjuvant radiotherapy followed by surgery survive longer than those who undergo other treatment strategies, US researchers report.
"Locally advanced NSCLC remains a significant therapeutic challenge," remark Matthew Koshy (University of Maryland School of Medicine, Baltimore) and colleagues in the International Journal of Radiation Oncology Biology Physics.
The results of several early Phase II studies have suggested a survival benefit from neoadjuvant chemoradiation followed by surgical resection, but subsequent phase III studies have failed to confirm this, they add.
Koshy and team therefore reviewed data from the Surveillance, Epidemiology, and End Results (SEER) database to examine if the outcomes of patients with Stage III NSCLC varied with the type of treatment they received.
The final sample size included 48,131 patients with a median follow-up period of 10 months. They were grouped by treatment type: radiation-only (RT; 67.2%), surgery-only (17.1%), surgery and postoperative radiation (S-RT; 12.9%), and neoadjuvant radiation followed by surgery (Neo-RT; 2.8%).
The researchers report that the 3-year overall survival rate varied significantly by treatment type, at 10% with RT only, 34% with S-RT, 37% with surgery only, and 45% with Neo-RT.
The respective 3-year lung cancer-specific survival rates were 13%, 41%, 46%, and 51%.
Multivariable analysis identified gender, race, laterality, T stage, N stage, and type of treatment as factors affecting survival.
After adjusting for those potential confounders, the researchers found that patients treated with S-RT, surgery alone, and RT alone had a 1.2-, 1.3-, and 2.3-fold increased risk for death, respectively, compared with those who received Neo- RT.
"We believe that neoadjuvant chemoradiation followed by surgery is appropriate in carefully selected healthy individuals with a limited burden of disease in the mediastinum," Koshy and co-authors conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Laura Dean