Can we optimize chemo-radiation and surgery in locally advanced stage III non-small cell lung cancer based on evidence from randomized clinical trials? A hypothesis-generating study

De Ruysscher, Dirk; Dehing, Cary; Bentzen, Søren M.; Houben, Ruud; Dekker, André; Wanders, Rinus; Borger, Jacques; Hochstenbag, Monique; Boersma, Liesbeth; Geskes, Gijs; Dingemans, Anne-Marie C.; Bootsma, Gerben; Lammering, Guido; Lambin, Philippe

doi:10.1016/j.radonc.2009.06.004

« Previous Next »Radiotherapy & Oncology
Volume 93, Issue 3 , Pages 389-395, December 2009

Can we optimize chemo-radiation and surgery in locally advanced stage III non-small cell lung cancer based on evidence from randomized clinical trials? A hypothesis-generating study

Dirk De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), The Netherlands
- Corresponding author. Address: Maastricht University Medical Center⁺, Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands.
Cary Dehing
- Maastro Clinic, Maastricht, The Netherlands
Søren M. Bentzen
- University of Wisconsin School of Medicine and Public Health, Department of Human Oncology, Madison, WI, USA
Ruud Houben
- Maastro Clinic, Maastricht, The Netherlands
André Dekker
- Maastro Clinic, Maastricht, The Netherlands
Rinus Wanders
- Maastro Clinic, Maastricht, The Netherlands
Jacques Borger
- Maastro Clinic, Maastricht, The Netherlands
Monique Hochstenbag
- Maastricht University Medical Center, Department of Pulmonology, The Netherlands
Liesbeth Boersma
- Maastro Clinic, Maastricht, The Netherlands
Gijs Geskes
- Maastricht University Medical Center, Department of Surgery, The Netherlands
Anne-Marie C. Dingemans
- Maastricht University Medical Center, Department of Pulmonology, The Netherlands
Gerben Bootsma
- Atrium Medical Center, Department of Pulmonology, Heerlen, The Netherlands
Guido Lammering
- Maastro Clinic, Maastricht, The Netherlands
Philippe Lambin
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), The Netherlands

Received 6 February 2009; received in revised form 27 May 2009; accepted 1 June 2009. published online 03 July 2009.

Abstract

Purpose

Improved local tumor control (LC) improves survival of patients with non-small cell lung cancer (NSCLC). We estimated the capability of surgical and non-surgical options to improve LC further in this disease.

Methods

Eligible studies were phase III trials reporting 2-year survival data as well as the incidence of LC and/or distant metastases. Effect estimates, as well as the statistical uncertainty of these, were combined in order to estimate the benefit in terms of LC from combining multiple modalities.

Results

It was estimated that the highest rates of LC can be obtained with high-dose concurrent chemo-radiation followed by surgery. In this situation, escalating the pre-operative radiation dose from 45 to 66Gy, delivered concurrently with chemotherapy, could increase LC from 58% to 76%. Toxicity may also be higher, but could not be estimated. Without surgery, the gain in LC from concurrent chemo-radiation versus sequential, corresponds to a radiation dose increase from 65 to 72Gy.

Conclusions

We hypothesize that high-dose concurrent chemo-radiation followed by surgery could be superior to other current treatment approaches for selected patients with stage III NSCLC, provided toxicity would be low. At present, high-dose concurrent chemo-radiation followed by surgery should be considered experimental.

Keywords: Non-small cell lung cancer, Optimization, Radiotherapy, Chemotherapy, Surgery, Local tumor control