Chemotherapy, Radiation Together Extend Lung Cancer Patients' Lives

Chemotherapy given at the same time as radiation therapy can help patients with a certain type of lung cancer live nearly 50 percent longer than they might have otherwise if the same treatment was given differently, according to an international team's analysis of several trial results.

Walter Curran Jr., M.D., professor and chair of Radiation Oncology at Jefferson Medical College of Thomas Jefferson University and Jefferson's Kimmel Cancer Center in Philadelphia, led one of six trials comparing the effectiveness of giving chemotherapy at the same time as radiation therapy versus giving radiation first, followed later by chemotherapy, to treat locally advanced non-small cell lung cancer (NSCLC).

According to Dr. Curran, there had been some controversy over whether simultaneous administration of chemotherapy and radiation for such cases was better than sequential delivery. In the United States, chemotherapy and radiation together have become the standard, whereas in other areas, such as Europe, for example, this has not been the case.

To try to resolve the matter, the International NSCLC Collaborative Group examined the results of more than 1,200 patients from six trials. The researchers found that the five-year survival rate was 10.6 percent with sequential therapy, while 15.1 percent with concurrent treatment. Dr. Curran presented the results last week at the meeting of the American Society for Therapeutic Radiology and Oncology in Los Angeles.

"That means a relative increase of nearly 50 percent," notes Dr. Curran, who led the Radiation Therapy Oncology Group (a Philadelphia-based cooperative clinical trials organization) trial. "We've demonstrated that the magnitude of benefit is observable in many studies, regardless of the regimen. I think it will be as persuasive as any data that this will change not only the tumor control rate but the chance for a long-term cure."

Dr. Curran explains that the only difference in the two treatments is that radiation is begun at another time. The drugs and radiation techniques are the same. "You're changing the first day of radiation from day 40 to day one, for example, and as a result, are changing the number of five-year survivors by between 40 percent and 50 percent," he says. According to these findings, theoretically, if there were 50,000 patients, approximately 5,000 who received sequential therapies would be alive in five years, and with concurrent, about 7,500.

"It is a new standard of care," he says about the results. "It's relatively broadly adopted in this country, but across the world, it hasn't been. This will be a very persuasive argument."