The Addition of Induction Chemotherapy Failed to Improve Therapeutic Outcome of Concurrent Chemoradiotherapy in Patients with Locally Advanced Non-small Cell Lung Cancer

ABSTRACT

PURPOSE: Although chemoradiotherapy (CRT) is a standard treatment for unresectable locally advanced non-small cell lung cancer (NSCLC), the optimal sequencing remains to be determined. Patients and Methods: The treatment results of induction chemotherapy followed by concurrent CRT (induction group, 32 patients) were retrospectively compared with those of concurrent CRT alone (concurrent group, 41 patients) in unresectable stage IIIA/IIIB NSCLC patients. In the induction group, 2 cycles of induction chemotherapy (etoposide/ifosfamide/ cisplatin: 24 patients, others: 8 patients) were followed by concurrent CRT (60 Gy/30 fractions, 6 mg/m2 of cisplatin daily), while the same concurrent CRT was administered in the concurrent group. RESULTS: The clinicopathological characteristics, including age, weight loss, histological types and clinical stage, showed no significant differences between the two groups, with the exception of a higher proportion of patients with an ECOG performance status of 2 in the concurrent group (3% vs. 27%, p=0.015). The overall toxicity was generally acceptable with only 1 treatment-related death from tracheoesophageal fistula in the induction group. The response rates after concurrent CRT were 41 and 54% for the induction and concurrent groups, respectively, which showed no significant difference (p=0.560). With a median follow-up of 13 (1~86) months, there was a trend toward an advantage in the concurrent group in relation to the median progression-free (6 months vs. 8.3 months, p=0.051) and overall survivals (12 months vs. 14.5 months, p=0.056). From a multivariate analysis, only a weight loss of more than 10% within 6 months was significantly associated with a poor survival (p=0.001). CONCLUSIONS: The addition of induction chemotherapy to concurrent CRT showed no any advantage over concurrent CRT alone in locally advanced NSCLC