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Radiation given twice daily in high doses may prolong survival of patients with early stage non-small cell lung cancer (NSCLC), according to results recently published in the Journal of Clinical Oncology.

Approximately 75% of patients who have lung cancer have a type of cancer referred to as 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 vary, depending on the stage, or extent, of cancer, but may include surgery, radiation therapy and/or chemotherapy. Early stage cancer refers to cancer that has not spread from its site of origin. Locally advanced NSCLC refers to cancer that has spread but is confined within the chest.

Although slight improvements have recently been made in the treatment of NSCLC, the surgical removal of cancer remains the crucial treatment component to achieving favorable long-term survival rates in patients with early stage disease. However, some patients are not candidates for surgery due to medical complications, or because their cancer cannot be removed by surgery. Innovative treatment strategies and combinations are needed for this group of patients in order to achieve acceptable treatment outcomes.

Researchers from Duke University Medical Center recently conducted a clinical trial evaluating the use of radiation administered twice-daily for 4.5 to 5 weeks in high doses to patients with NSCLC. Patients in this trial had either early or locally advanced stages of cancer that could not be surgically removed. The average survival time following twice-daily radiation for patients with early stage NSCLC was 34 months. Historically, the average survival time for this group of patients following standard treatment is approximately 22 months. Conversely, patients with locally advanced cancer did not show an improvement in survival time following twice-daily radiation compared to the standard radiation regimen.

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These results indicate that high-dose radiation given twice daily may prolong survival for patients with early stage, inoperable NSCLC. However, patients who have locally advanced cancer appear to receive no benefit from this treatment strategy. One critical problem that may hinder the achievement of long-term survival for patients with locally advanced NSCLC is the return of their cancer in distant locations in the body. Several studies have indicated that the use of molecular markers may help to predict which patients are at risk for a distant recurrence1. These patients may benefit from treatment including systemic chemotherapy. Future studies may help define the use of molecular markers in determine optimal treatment strategies for patients with locally advanced NSCLC.

Patients with early stage NSCLC may wish to speak with their physician about the risks and benefits of receiving twice daily high-dose radiation therapy. Patients with locally advanced NSCLC also may wish to speak with their physicians about the participation in a clinical trial evaluating novel treatment strategies. Two sources of information about ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients. (Journal of Clinical Oncology, Vol 19, No 3, pp 705-711, 2001)

1 D’Amico TA, et al.

Journal of Thoracic and Cardiovascular Surgery, Vol 117, pp 736-743, 1000

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