Lung Cancer.pdf

Nonsurgical Treatment of Non–Small Cell Lung Cancer 149
Table 8–4. Schema for Radiation Therapy Oncology Group Trial 88–08:
Effect of Chemotherapy on Failure Patterns in Patients with
Unresectable NSCLC Treated with Radiation Therapy
Stratification criteria
Histology: squamous vs other
Karnofsky performance status: 70–80 vs 90–100
Stage: II vs IIIA vs IIIB
Arm 1 (conventional radiation therapy)
60 Gy in daily 2.0-Gy fractions over 6 weeks
Arm 2 (chemotherapy followed by conventional radiation therapy)
Vinblastine weekly for 6 weeks
Cisplatin on days 1 and 29
Conventional radiation therapy beginning on day 50
Arm 3 (hyperfractionated radiation therapy)
69.6 Gy in twice-daily 1.2-Gy fractions over 6 weeks
were randomly assigned to treatment with conventional radiation therapy
alone, hyperfractionated radiation therapy alone, or chemotherapy
followed by conventional radiation therapy. Treatment details are given
in Table 8– 4. The median survival in the group that received chemotherapy
was 13.8 months, compared to 11.4 months among the patients who
received hyperfractionated radiation therapy. The 2-year survival rate
was 32% among the patients who received combined treatment versus
19% among the patients who received hyperfractionated radiation therapy
(P .003).
RTOG trial 91–06 was a phase II trial in which patients received a combination
of the most effective radiation therapy regimen identified in RTOG
trial 83–11 (a total dose of 69.6 Gy) and concurrent oral etoposide and intravenous
cisplatin (Lee et al, 1996). Eligibility criteria included unresectable
NSCLC, good performance status, and weight loss less than 5%. Among the
76 patients enrolled, the 2-year survival rate was 40%, and the median survival
was 19.7 months (Lee et al, 1996). This median survival was better
than the median survival of 10.3 months in RTOG trial 83–11 (twice-daily
radiation therapy alone) (Table 8–5) (Komaki et al, 1997b). However, acute
esophagitis was significantly more common among the patients treated
with twice-daily radiation therapy and concurrent chemotherapy.
At M.D. Anderson, RTOG trial 92–04 was activated in 1992 to compare 2
combinations of chemotherapy and radiation therapy in patients with inoperable
stage II or III NSCLC, a Karnofsky performance status score of 70 or
higher, and minimal weight loss (Komaki et al, 1997a, in press). Treatment
details are given in Table 8–6. The arm-1 treatment (induction chemotherapy
followed by concurrent chemoradiation) was based on previous RTOG