Aggressive treatment with neoadjuvant chemotherapy plus radiation therapy followed by surgery may significantly improve survival of patients with stage III non-small cell lung cancer, according to results from a clinical trial published in the journal Cancer. Neoadjuvant refers to the administration of therapy before surgery.
Approximately 75% of patients who have lung cancer have a type of cancer referred to as non-small cell lung cancer (NSCLC). There are actually many different types of lung cancer that are classified as NSCLC and are named according to the type of cell within the lung in which the cancer originated. These include epidermoid or squamous carcinoma, adenocarcinoma, large cell carcinoma, adenosquamous carcinoma and undifferentiated carcinoma. Treatment options for NSCLC depend on the stage, or extent of the cancer, but may include surgery, radiation therapy and/or chemotherapy. Stage III NSCLC is characterized by cancer that has started in the lung and spread to areas within the chest. With current treatment methods, 5 year survival rates for patients with this disease are less than 20%. Therefore, researchers are currently evaluating new treatment strategies in the hopes of improving cure rates for patients with NSCLC.
Some recent clinical studies have shown that patients with stage III NSCLC may benefit from neoadjuvant chemotherapy plus radiation therapy prior to surgery. There are four separate reasons for the use of neoadjuvant or pre-operative treatment strategy: 1) pre-operative treatment can often shrink lung cancers, and therefore may allow more complete surgical removal of the cancer; 2) surgery involving the removal of a smaller cancer is less extensive and may decrease adverse complications associated with extensive surgery; 3) pre-operative treatment may shrink the cancer enough to allow surgery for patients who otherwise would not be candidates for surgery; 4) immediate treatment with chemotherapy and radiation may prevent the spread of cancer by killing cancer cells without delay.
Researchers from several medical centers in Boston recently evaluated the effectiveness of an aggressive neoadjuvant chemotherapy and radiation treatment approach prior to surgery in NSCLC patients. Forty-six patients with stage III NSCLC were involved in this clinical trial. Each patient received two courses of chemotherapy administered concurrently with high doses of radiation therapy prior to surgical removal of their cancer. Nearly 80% of these patients were able to undergo surgical removal of their cancer following treatment. Almost half of the patients who underwent surgery were alive 5 years following treatment. Importantly, no patients died from treatment related complications which suggests that this is a safe and tolerable approach.
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These results appear to indicate a significant improvement in survival with the use of neoadjuvant treatment for patients with stage III NSCLC. The expansion of effective treatment options for this disease is very encouraging, as these patients are considered to have a poor prognosis following current standard treatments. Patients with NSCLC may wish to speak with their physicians about the risks and benefits of participation in a clinical trial utilizing this or other neoadjuvant treatment strategies. Two sources of information on ongoing clinical trials that can be discussed with a doctor include listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (Cancer, Vol 89, No 9 pp 1946-1952, 2000)
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