Standard vs High-Dose Chemoradiation in Stage 3 Non-Small Cell Lung Cancer

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The use of cetuximab in stage 3 NSCLC was not beneficial.
The use of cetuximab in stage 3 NSCLC was not beneficial.

HealthDay News — For patients with stage 3 non-small-cell lung cancer, standard-dose (SD) chemoradiation therapy is better than high-dose (HD) treatment, with higher 5-year overall survival rates, according to a study presented at the annual meeting of the American Society for Radiation Oncology (ASTRO), held from September 24 to 27 in San Diego.

Jeffrey D. Bradley, MD, from the Washington University School of Medicine in St. Louis, and colleagues conducted a phase 3 randomized trial to compare SD (60 Gy) with high-dose (HD; 74 Gy) chemoradiation therapy and to assess the efficacy of cetuximab for 496 patients with stage 3 non-small-cell lung cancer. Patients were followed for a median of 5.1 years for the primary end point of overall survival.

The researchers found that for the SD and HD arms, the median overall survival was 28.7 vs 20.3 months, respectively. The 5-year overall survival rates were 32.1% vs 23% (P =.004), and progression-free survival rates were 18.3% vs 13% (P =.055), favoring the SD arm. In multivariable analysis, factors affecting overall survival included radiation dose favoring SD, tumor location, institution accrual volume, esophagitis/dysphagia, planning target volume, and V5 heart dose/volume. Cetuximab use conferred no benefit.

"This report also confirms that using a higher radiation dose is not beneficial and can lead to detrimental outcomes including lower survival rates and increased side effects," Dr Bradley said in a statement.

Disclosures: Several authors disclosed financial ties to medical technology and pharmaceutical companies. Eli Lilly provided funding for the study.

Reference

Long-term survival rates more than double previous estimate for locally advanced lung cancer [press release]. San Diego, CA: American Society for Radiation Oncology; September 25, 2017. Accessed October 2, 2017.

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