According to results recently presented at the 45th annual meeting of the American Society for Therapeutic Radiation and Oncology, more frequent radiation over a shorter time period appears to improve survival compared to standard schedules in the treatment of stages IIIA-IIIB non-small cell lung cancer.

Lung cancer is the leading cause of cancer deaths in the United States. Non-small cell lung cancer (NSCLC) accounts for approximately 80% of lung cancers and refers to the type of cell within the lung that the cancer originated. Stages IIIA-IIIB NSCLC refer to cancer that has spread from its site of origin, but not outside the chest. Standard treatment approaches for stages IIIA-IIIB NSCLC include chemotherapy and radiation therapy, with surgery in some cases. Since long-term survival is suboptimal for patients diagnosed with stages IIIA-IIIB NSCLC, researchers are evaluating new scheduling of treatment regimens, including radiation therapy.

Researchers affiliated with the Eastern Cooperative Oncology Group recently conducted a multi-institutional clinical trial to compare different radiation schedules in the treatment of stages IIIA-IIIB NSCLC that was considered inoperable. This trial involved 119 patients who were initially treated with the chemotherapy agents carboplatin (Paraplatin®) and paclitaxel (Taxol®). Patients were then divided into two groups: one group received radiation once per day for 32 days, or radiation 3 times per day over a period of only 2.5 weeks (hyperfractionated accelerated radiotherapy, or HART). Anti-cancer response rates were equal between the two groups (23%-24%). However, the average duration of survival was 21 months for patients treated with HART, compared to only 12 months for those treated with the standard, once-daily radiation schedule. Survival at 2 years was 37% and 28% for patients treated with HART and standard radiation, respectively. Survival at 3 years was 20% and 15% for those treated with HART and standard radiation, respectively. Overall, severe side effects were more common in patients treated with standard radiation, except for esophagitis (inflammation of the esophagus), which was more prevalent in patients treated with HART.

The researchers concluded that HART following induction chemotherapy appears to significantly improve long-term survival for patients with inoperable stages IIIA-IIIB NSCLC, with acceptable side effects. These results are consistent with a European clinical trial that compared HART and once-daily radiation without chemotherapy. Patients with inoperable stages IIIA-IIIB NSCLC may wish to speak with their physician about the risks and benefits of HART or the participation in a clinical trial evaluating novel radiation techniques. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( cancer.gov) and www.cancerconsultants.com. Personalized clinical trials are also performed on behalf of patients at cancerconsultants.com.

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Reference: Mehta M, Wang W, Johnson D, et al. Induction chemotherapy followed by standard thoracic radiotherapy vs. hyperfractionated accelerated radiotherapy for patients with unresectable stage IIIA and B non-small cell lung cancer: Phase III study of Eastern Cooperative Oncology Group (ECOG 2597). Proceedings from the 45th annual meeting of the American Society for Therapeutic Radiation and Oncology. October 2003. Abstract #29. S141.

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