Researchers from Germany have reported that there was no advantage with the addition of preoperative hyperfractionated radiochemotherapy (hfRTCT) or post-operative radiotherapy (RT) to neoadjuvant chemotherapy and surgery in the treatment of patients with stage IIIA and IIIB non-small cell lung cancer (NSCLC). These results were reported in the plenary session of the 46th annual meeting of the American Society of Therapeutic Radiology and Oncology held in Atlanta GA, Oct 3-7, 2004.

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Under most circumstances, NSCLC is not curable. Current treatments include surgery, chemotherapy and radiation.

This phase III clinical trial involved 558 patients with stage IIIA or IIIB NSCLC. More than half of the patients (67%) had stage IIIB disease. All patients received 3 cycles of Platinol®/Etoposide chemotherapy. Half of the patients then received hfRTCT followed by surgery and the other half underwent surgery followed by radiation therapy. HfRTCT consisted of radiation therapy with concurrent Paraplatin®/Vindesin. If patients receiving hfRTCT were unable to undergo surgery, they received further hfRTCT

Three years after treatment, results indicate that patients from both groups lived and were cancer-free for a similar length of time. Also, the same number of patients from both groups was found to be not eligible for surgery (see table).

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The hfCTRT produced significantly more grade III/IV esophagitis (19% vs 3%) and damage to blood cells (9% vs 1%). Pneumonitis was more common in those that received standard post-op RT (1% vs. 6%).

Reference: Ruebe C, RiesenbeckD, Semik M, et al. Neoadjuvant chemotherapy followed by preoperative radiochemotherapy (hfRTCT) plus surgery or surgery plus postoperative radiotherapy in stage III non-small cell lung cancer: results of a randomized phase III trial of the German Lung Cancer Cooperative Group. Proceedings from the 46th annual meeting of the American Society for Therapeutic Radiology and Oncology, Atlanta GA, Oct 2004, Abstract #1.

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