According to results recently published in the Journal of Clinical Oncology, long-term outcomes for advanced non-small cell lung cancer (NSCLC) are superior following concurrent treatment with chemotherapy plus radiation therapy compared with sequential chemotherapy plus radiation therapy.

Lung cancer remains the annual leading cause of cancer-related deaths in the United States. In fact, lung cancer causes more deaths than breast cancer, colon cancer, and prostate cancer combined. NSCLC, the most common form of lung cancer, refers to the type of cell within the lung where the cancer originated. If NSCLC cannot be surgically removed, either due to its anatomical position, its extent of spread, or a patient’s overall medical condition, it is referred to as “unresectable”. Standard treatment for unresectable NSCLC typically includes chemotherapy with or without radiation therapy.

Concurrent therapy means that chemotherapy and radiation therapy are administered at the same time. In sequential therapy, one type of treatment does not begin until the initial treatment is completed. Although earlier trials have demonstrated that concurrent chemotherapy and radiation therapy appears superior to sequential in the treatment of NSCLC, long-term results comparing these two approaches remain limited.

Researchers from France conducted a multi-institutional clinical trial directly comparing concurrent chemotherapy and radiation therapy to sequential radiation therapy in patients with unresectable NSCLC and have recently reported long-term outcomes. This trial included 205 patients with stage III unresectable NSCLC who were treated with either chemotherapy consisting of cisplatin and vinorelbine, followed by radiation (concurrent); or chemotherapy consisting of cisplatin and etoposide in addition to radiation therapy (sequential), followed by additional chemotherapy consisting of cisplatin and vinorelbine. The average overall survival rates, as well as long-term survival, were superior in the group of patients treated with concurrent therapy, compared to those treated with sequential therapy.

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The average duration of survival was 16.3 months in patients treated with concurrent therapy, compared with 14.5 months for those treated with sequential therapy. Survival at 2-, 3-, and 4- years was 39%, 25%, and 21%, respectively for patients treated with concurrent therapy, compared with 26%, 19% and 14%, respectively for patients treated with sequential therapy. Side effects affecting the esophagus were greater in the group treated with concurrent therapy.

The researchers concluded that concurrent chemotherapy plus radiation therapy appears to provide superior long-term survival compared to sequential chemotherapy plus radiation therapy in the treatment of unresectable, locally advanced NSCLC. Patients with unresectable NSCLC may wish to speak with their physician regarding their individual risks and benefits of concurrent therapy or the participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.

Reference: Fournel P, Robinet G, Thomas P, et al. Randomized Phase III Trial of Sequential Chemoradiotherapy Compared With Concurrent Chemoradiotherapy in Locally Advanced Non–Small-Cell Lung Cancer: Groupe Lyon-Saint-Etienne d’Oncologie Thoracique–Groupe Français de Pneumo-Cancérologie NPC 95-01 Study. Journal of Clinical Oncology. 2005; 23: 5910-5917.

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