Adjuvant radiotherapy in non-small cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Treatment of stage II non-small cell lung cancer. Adjuvant radiotherapy versus combined sequential chemotherapy followed by radiotherapy in the treatment of resected nonsmall cell lung carcinoma. A randomized trial of 267 patients The effect of radiotherapy on the survival of non-small cell lung cancer patients. A randomized study of high-dose split course radiotherapy preceded by high-dose chemotherapy versus high-dose radiotherapy only in locally advanced non-small-cell lung cancer. An EORTC Lung Cancer Cooperative Group trial. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. Improved survival in patients with early stage low‐grade follicular lymphoma treated with radiation Neoadjuvant chemotherapy for non-small cell lung cancer. Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer: A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial. Postoperative adjuvant therapy for stage II non-small-cell lung cancer. Virtual Reality Bringing a New Reality to Postthoracotomy Lung Cancer Patients Via a Home-Based Exercise Intervention Targeting Fatigue While Undergoing Adjuvant Treatment Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. Image-Guided Hypofractionated Small Volume Radiotherapy of Non-Small Cell Lung Cancer – Feasibility and Clinical Outcome Radiation therapy oncology group protocol 02-29: a phase II trial of neoadjuvant therapy with concurrent chemotherapy and full-dose radiation therapy followed by surgical resection and consolidative therapy for locally advanced non-small cell carcinoma of the lung. Split-course versus continuous thoracic radiation therapy for limited-stage small-cell lung cancer: final report of a randomized phase III trial. The International Atomic Energy Agency (IAEA) randomized trial of palliative treatment of incurable locally advanced non small cell lung cancer (NSCLC) using radiotherapy (RT) and chemotherapy (CHT) in limited resource setting.
BACKGROUND AND PURPOSE To evaluate the benefits and the drawbacks of post-operative radiotherapy in completely resected Stage I ( a and b ) non-small cell lung cancer ( NSCLC ) . MATERIAL S AND METHODS Patients with pathological Stages Ia and Ib NSCLC have been r and omized into two groups : Group 1 ( G1 ) received adjuvant radiotherapy , Group 0 ( G0 ) the control group did not receive any adjuvant therapy .  Local control , toxicity and survival have been evaluated . RESULTS Between July 1989 and June 1997 , 104 patients with pathological stage I NSCLC have been enrolled in this study . Fifty-one patients were r and omized to G1 and 53 to G0 . Six patients have been excluded from the study due to incomplete follow-up data . Regarding local control , one patient in the G1 group had a local recurrence ( 2.2 % ) while in the G0 12 local recurrences have been observed ( 23 % ) . Seventy-one percent of patients are disease-free at 5 years in G1 and 60 % in G0 ( P=0.039 ) . Overall 5-year survival ( Kaplan-Meier ) showed a positive trend in the treated group : 67 versus 58 % ( P=0.048 ) . Regarding toxicity in G1 , six patients experienced a grade 1 acute toxicity . Radiological evidence of long-term lung toxicity , with no significant impairment of the respiratory function , has been detected in 18 of the 19 patients who have been diagnosed as having a post-radiation lung fibrosis . CONCLUSIONS Adjuvant radiotherapy gave good results in terms of local control in patients with completely resected NSCLC with pathological Stage I. Overall 5-year survival and disease-free survival showed a promising trend . Treatment-related toxicity is acceptable OBJECTIVES Stage III non-small cell lung cancer ( NSCLC ) describes a heterogeneous population with disease presentation ranging from apparently resectable tumors with occult microscopic nodal metastases to unresectable , bulky nodal disease . This review up date s the published clinical trials since the last American College of Chest Physicians guidelines to make treatment recommendations for this controversial subset of patients . METHODS Systematic search es were conducted through MEDLINE , Embase , and the Cochrane Data base for Systematic Review up to December 2011 , focusing primarily on r and omized trials , selected meta-analyses , practice guidelines , and review s. RESULTS For individuals with stage IIIA or IIIB disease , good performance scores , and minimal weight loss , treatment with combined chemoradiotherapy results in better survival than radiotherapy alone . Consolidation chemotherapy or targeted therapy following definitive chemoradiation for stage IIIA is not supported . Neoadjuvant therapy followed by surgery is neither clearly better nor clearly worse than definitive chemoradiation . Most of the arguments made regarding patient selection for neoadjuvant therapy and surgical resection provide evidence for better prognosis but not for a beneficial impact of this treatment strategy ; however , weak comparative data suggest a possible role if only lobectomy is needed in a center with a low perioperative mortality rate . The evidence supports routine platinum-based adjuvant chemotherapy following complete resection of stage IIIA lung cancer encountered unexpectedly at surgery . Postoperative radiotherapy  improves local control without improving survival . CONCLUSIONS Multimodality therapy is preferable in most subsets of patients with stage III lung cancer . Variability in the patients included in r and omized trials limits the ability to combine results across studies and thus limits the strength of recommendations in many scenarios . Future trials are needed to investigate the roles of individualized chemotherapy , surgery in particular cohorts or setting s , prophylactic cranial radiation , and adaptive radiation Based on clinical assessment alone , patients with stage II non-small cell lung cancer ( NSCLC ) comprise only 5 % of all patients with NSCLC . In addition , patients with stage II NSCLC represent a heterogeneous group , since stage II consists of patients with T1 - 2N1 or T3N0 tumors . By definition , patients with tumor invading the chest wall apex , mediastinum , diaphragm , or even the mainstem bronchus may all have T3 tumors . The extent of the data available regarding treatment of each of these different groups is therefore limited . The quality of the data is limited as well , because information often comes from small series of patients . Studies of adjuvant therapy after complete resection of stage II NSCLC are an important exception to this generalization , since data from large , r and omized studies of adjuvant radiation therapy , chemotherapy , or a combination of the two are available for analysis . Superior sulcus tumors are discussed elsewhere in these guidelines Background . The effect of adjuvant chemotherapy after resection of nonsmall cell lung cancer ( NSCLC ) remains an unresolved question PURPOSE To determine if thoracic radiotherapy improves the survival of non-small cell lung cancer ( NSCLC ) patients . METHODS AND MATERIAL S A Cox proportional hazards model with prognostic and treatment covariates was estimated using prospect i ve data for 129 NSCLC patients presenting at the Victoria Clinic ( ViCC ) of the British Columbia Cancer Agency ( BCCA ) 1990 - 1991 . The estimated model was simulated to predict survival curves for groups of patients with and without treatment . The difference between the predicted median survival with treatment and without treatment is the gain in survival attributable to treatment . RESULTS After adjusting for the effect of TNM staging , Karnofsky performance status , weight loss , tumor size , and tumor histology on survival , high-dose palliative radiotherapy ( RT ) ( 30 - 50 Gy in 10 - 20 fractions ) increased median survival by 79 days ( 95 % confidence interval : 31 - 106 days ) , and lowered the relative risk of death rate to 0.53 ( 95 % confidence interval : 0.35 - 0.85 ) . Radical RT ( 50 or more Gy , in 20 or more fractions ) increased median survival by 424 days ( 95 % confidence interval : 302 - 488 days ) , and lowered the relative risk of death to 0.24 ( 95 % confidence interval : 0.14 - 0.43 ) . CONCLUSION Our results support the hypothesis that the increased survival of patients receiving aggressive palliative , or radical , RT  is due not solely to patient selection , but also partly to a response to treatment BACKGROUND The treatment results of radiotherapy in stage III non-small-cell lung cancer are very poor . Several phase II studies showed that neoadjuvant chemotherapy followed by radiotherapy was feasible in this patient group and suggested that treatment outcome might improve . A r and omized phase II study was performed addressing the response rate and morbidity of high-dose split course radiotherapy ( RT ) versus the same radiotherapy preceded by high-dose chemotherapy ( CT ) in patients with stage III non-small-cell lung cancer . PATIENTS AND METHODS Seventy eligible patients were r and omized in this study .  CT consisted of cisplatin 100 mg/m2 days 1 and 22 , and vindesine 3 mg/m2 on days 1 , 8 , 22 and 29 . Radiotherapy started on day 43 in the combined arm and immediately in the RT-only arm . The primary tumour and the regional nodes were treated by 30 Gy/10 fractions/2 weeks and after the split by a second course of 25 Gy/10 fractions/2 weeks . In the combined arm a third CT cycle was planned during the split between RT courses . RESULTS In the CT + RT arm 34 patients were evaluable for response and toxicity and 30 patients in the RT only arm . After completion of treatment 7 patients had a complete response ( 2 in the CT plus RT arm , 5 in the RT alone arm ) and 26 patients a partial response ( 13 in the CT plus RT arm , 13 in the RT alone arm ) for an overall response rate of 52 % ( 95 % CI 39%-65 % ) . Acute toxicity was worse in the combined treatment arm with grade 4 leucocytopenia in 8 patients and thrombocytopenia grade 4 in one patient . Three patients had reversible renal toxicity grade 2 . There was one toxic death in the RT plus CT arm . There was no enhancement of acute or late radiation pulmonary or oesophageal toxicity . Time to progressive disease ( median 30 vs. 35 weeks ) and overall survival time ( median 12 months ) were equal in both treatment arms . CONCLUSION High-dose radiotherapy preceded by high-dose chemotherapy was more toxic than radiotherapy alone and did not result in this study in any benefit in terms of response rate , time to progressive disease and overall survival BACKGROUND For many years , high dose radiation therapy was the st and ard treatment for patients with locally or regionally advanced non-small-cell lung cancer ( NSCLC ) , despite a 5-year survival rate of only 3%-10 % following such therapy . From May 1984 through May 1987 , the Cancer and Leukemia Group B ( CALGB ) conducted a r and omized trial that showed that induction chemotherapy before radiation therapy improved survival during the first 3 years of follow-up . PURPOSE This report provides data for 7 years of follow-up of patients enrolled in the CALGB trial . METHODS The patient population consisted of individuals who had clinical or surgical stage III , histologically documented NSCLC ; a CALGB performance status of 0 - 1 ; less than 5 % loss of body weight in the 3 months preceding diagnosis ; and radiographically visible disease . Patients were r and omly assigned to receive either 1 ) cisplatin ( 100 mg/m2 body surface area intravenously on days 1 and 29 ) and vinblastine ( 5 mg/m2 body surface area intravenously weekly on days 1 , 8 , 15 , 22 , and 29 ) followed by radiation therapy with 6000 cGy given in 30 fractions beginning on day 50 ( CT-RT group ) or 2 ) radiation therapy with 6000 cGy alone beginning on day 1 ( RT group ) for a maximum duration of 6 - 7 weeks . Patients were evaluated for tumor regression if they had measurable or evaluable disease and were monitored for toxic effects , disease progression , and date of death . RESULTS There were 78 eligible patients r and omly assigned to the CT-RT group and 77 r and omly assigned to the RT group . Both groups were similar in terms of sex , age , histologic cell type , performance status , substage of disease , and whether staging had been clinical or surgical . All patients had measurable or evaluable disease at the time of r and om assignment to treatment groups . Both groups received a similar quantity and quality of radiation therapy . As previously reported , the rate of tumor response , as determined radiographically , was 56 % for the CT-RT group and 43 % for the RT group ( P = .092 ) . After more than 7 years of follow-up , the median survival remains greater for the CT-RT group ( 13.7 months ) than for the RT group ( 9.6 months ) ( P = .012 ) as ascertained by the logrank test ( two-sided ) . The percentages of patients surviving after years 1 through 7 were 54 , 26 , 24 , 19 , 17 , 13 , and 13 for the CT-RT group and 40 , 13 , 10 , 7 , 6 , 6 , and 6 for the RT group . CONCLUSIONS Long-term follow-up confirms that patients with stage III NSCLC who receive 5 weeks of chemotherapy with cisplatin and vinblastine before radiation therapy have a 4.1-month increase in median survival . The use of sequential chemotherapy-radiotherapy increases the projected proportion of 5-year survivors by a factor of 2.8 compared with that of radiotherapy alone . However , inasmuch as 80%-85 % of such patients still die within 5 years and because treatment failure occurs both in the irradiated field and at distant sites in patients receiving either sequential chemotherapy-radiotherapy or radiotherapy alone , the need for further improvements in both the local and systemic treatment of this disease persists External beam radiation therapy ( RT ) is the st and ard treatment for stage I‐II , grade 1‐2 follicular lymphoma . Because of an indolent natural history , some advocate alternative management strategies , including watchful waiting for this disease . The relative improvement in outcomes for patients treated with and without RT has never been tested in r and omized trials Even with aggressive surgical treatment , relapse rates remain high for patients with resectable non-small cell lung cancer ( NSCLC ) . In an effort to improve survival in these patients , numerous clinical trials have evaluated neoadjuvant and adjuvant chemotherapy . Three large , r and omized clinical trials and two meta-analyses have demonstrated a survival benefit for adjuvant cisplatin-based chemotherapy compared to surgery alone . Adjuvant chemotherapy has become the st and ard of care for patients with resected NSCLC . A neoadjuvant approach offers several potential advantages over adjuvant therapy , including earlier treatment of micrometastatic disease , improved compliance and pathologic confirmation of efficacy . R and omized trials have shown neoadjuvant therapy to be feasible and safe and some studies have yielded promising efficacy . The applicability of these results has been limited due to patient heterogeneity , imprecise staging and lack of st and ardization with respect to inclusion of radiation therapy . With novel agents , improved staging , better supportive care and relevant molecular markers , a neoadjuvant strategy is promising for future clinical trials in NSCLC Purpose Although intensity-modulated radiation therapy ( IMRT ) is increasingly used to treat locally advanced non-small-cell lung cancer ( NSCLC ) , IMRT and three-dimensional conformal external beam radiation therapy ( 3D-CRT ) have not been compared prospect ively . This study compares 3D-CRT and IMRT outcomes for locally advanced NSCLC in a large prospect i ve clinical trial . Patients and Methods A secondary analysis was performed to compare IMRT with 3D-CRT in NRG Oncology clinical trial RTOG 0617 , in which patients received concurrent chemotherapy of carboplatin and paclitaxel with or without cetuximab , and 60- versus 74-Gy radiation doses .  Comparisons included 2-year overall survival ( OS ) , progression-free survival , local failure , distant metastasis , and selected Common Terminology Criteria for Adverse Events ( version 3 ) ≥ grade 3 toxicities . Results The median follow-up was 21.3 months . Of 482 patients , 53 % were treated with 3D-CRT and 47 % with IMRT . The IMRT group had larger planning treatment volumes ( median , 427 v 486 mL ; P = .005 ) ; a larger planning treatment volume/volume of lung ratio ( median , 0.13 v 0.15 ; P = .013 ) ; and more stage IIIB disease ( 30.3 % v 38.6 % , P = .056 ) . Two-year OS , progression-free survival , local failure , and distant metastasis-free survival were not different between IMRT and 3D-CRT . IMRT was associated with less ≥ grade 3 pneumonitis ( 7.9 % v 3.5 % , P = .039 ) and a reduced risk in adjusted analyses ( odds ratio , 0.41 ; 95 % CI , 0.171 to 0.986 ; P = .046 ) . IMRT also produced lower heart doses ( P < .05 ) , and the volume of heart receiving 40 Gy ( V40 ) was significantly associated with OS on adjusted analysis ( P < .05 ) . The lung V5 was not associated with any ≥ grade 3 toxicity , whereas the lung V20 was associated with increased ≥ grade 3 pneumonitis risk on multivariable analysis ( P = .026 ) . Conclusion IMRT was associated with lower rates of severe pneumonitis and cardiac doses in NRG Oncology clinical trial RTOG 0617 , which supports routine use of IMRT for locally advanced NSCLC BACKGROUND Stage II non-small-cell lung cancer is regarded as one of the early lung cancers . Although resection , including the mediastinal lymph nodes , is currently regarded as the st and ard treatment , the survival rate of this disease is not encouraging . It is well known that the most common causes of death are locoregional recurrences or distant metastases , or both . However , the best adjuvant treatment to improve survival is as controversial an issue as ever . METHODS This study was design ed as a r and omized , blinded , two-armed study with operation and adjuvant radiotherapy in one arm , versus operation and adjuvant mitomycin C ( 10 mg/m2 ) , vinblastine ( 6 mg/m2 ) , and cisplatin ( 100 mg/m2 ) ( MVP ) chemotherapy in the other arm . We assigned 57 resected patients with pathologic proven stage II non-small cell lung cancer to the groups according to our eligibility criteria . RESULTS The most common pattern of recurrence was distant metastases , and nearly all the recurrences ( 17 of 18 patients ) in both groups were found within 2 years after operation . The rates of the locoregional and distant metastases were 3.6 % and 46.4 % in the adjuvant radiotherapy group and 6.9 % and 10.3 % in the adjuvant chemotherapy group ( p = 0.018 ) . The 5-year disease-free survival rates were 52.0 % in the adjuvant radiotherapy group and 74.0 % in the adjuvant chemotherapy group ( p = 0.16 , log-rank test ) . The 2-year , 5-year , and 6-year survival portions were 60.3 % , 56.5 % , and 28.3 % in the adjuvant radiotherapy group , and 82.8 % , 70.1 % , and 60.1 % in the adjuvant chemotherapy group ( p = 0.01 , p = 0.17 , and p = 0.03 , Z-test ) . The difference of the actuarial survival between these two groups was somewhat significant ( p = 0.09 , log-rank test ) . CONCLUSIONS Our results suggest that the addition of adjuvant MVP chemotherapy may reduce the distant metastasis rates and prolong the survival of the surgically resected stage II non-small-cell lung cancer patients Background : Little is known about rehabilitation for postthoracotomy non – small cell lung cancer ( NSCLC ) patients . This research uses a perceived self-efficacy-enhancing light-intensity exercise intervention targeting a priority symptom , cancer-related fatigue ( CRF ) , for postthoracotomy NSCLC patients . This article reports on phase II of a 2-phase study . Phase I focused on initiation and tolerance of exercise during the 6 weeks immediately after thoracotomy , whereas phase II addressed maintenance of exercise for an additional 10 weeks including participants initiating and completing chemotherapy and /or radiation therapy . Objective : The objective of this study was to investigate the feasibility , acceptability , and preliminary efficacy of an exercise intervention for postthoracotomy NSCLC patients to include those initiating and completing adjuvant therapy . Interventions / Methods : A single-arm design composed of 7 participants postthoracotomy for NSCLC performed light-intensity exercises using an efficacy-enhancing virtual-reality approach using the Nintendo Wii Fit Plus . Results : Despite most participants undergoing chemotherapy and /or radiation therapy , participants adhered to the intervention at a rate of 88 % with no adverse events while giving the intervention high acceptability scores on conclusion . Likewise , participants ’ CRF scores improved from initiation through the conclusion of the intervention with perceived self-efficacy for walking at a light intensity continuously for 60 minutes , improving significantly upon conclusion over presurgery values . Conclusions : Postthoracotomy NSCLC patients maintained exercise for an additional 10 weeks while undergoing adjuvant therapy showing rehabilitation potential because the exercise intervention was feasible , safe , well tolerated , and highly acceptable showing positive changes in CRF self-management . Implication s for Practice : A r and omized controlled trial is needed to further investigate these relationships PURPOSE Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer ( EC ) . We assessed whether the type of radiation therapy ( RT ) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation ( nCRT ) . PATIENTS AND METHODS Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were review ed .  3D conformal RT ( 3D ) , intensity modulated RT ( IMRT ) and proton beam therapy ( PBT ) were used for 214 ( 37 % ) , 255 ( 44 % ) , and 111 ( 19 % ) patients , respectively . Postoperative outcomes included pulmonary , GI , cardiac , wound healing complications , length of in-hospital stay ( LOS ) , and 90-day postoperative mortality . Cox model fits , and log-rank tests both with and without Inverse Probability of treatment Weighting ( IPW ) were used to correct for bias due to non-r and omization . RESULTS RT modality was significantly associated with the incidence of pulmonary , cardiac and wound complications , which also bore out on multivariate analysis . Mean LOS was also significantly associated with treatment modality ( 13.2days for 3D ( 95%CI 11.7 - 14.7 ) , 11.6days for IMRT ( 95%CI 10.9 - 12.7 ) , and 9.3days for PBT ( 95%CI 8.2 - 10.3 ) ( p<0.0001 ) ) . The 90day postoperative mortality rates were 4.2 % , 4.3 % , and 0.9 % , respectively , for 3D , IMRT and PBT ( p=0.264 ) . CONCLUSIONS Advanced RT technologies ( IMRT and PBT ) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D , with PBT displaying the greatest benefit in a number of clinical endpoints . Ongoing prospect i ve r and omized trial will be needed to vali date these results Purpose : Local hypofractionated stereotactic radiation treatment ( hfSRT ) of early stage non-small cell lung cancer ( NSCLC ) represents a highly effective treatment alternative in medically inoperable patients . Method : Between June 2007 and December 2010 , 65 patients with NSCLC were treated with image-guided hypofractionated radiotherapy . The Union Internationale Contre le Cancer ( UICC ) stage distribution was : IA , n = 19 ; IB , n = 15 ; IIB , n = 5 ; IIIA , n = 10 ; IIIB , n = 6 ; and IV , n = 10 . The fractionation schedule used was 3 × 12.5 Gy ( n = 36 ) prescribed to the encompassing 67 % isodose line for peripheral primary tumours , and 8 × 6 Gy ( n = 26 ) or 8 × 5 Gy ( n = 3 ) prescribed to the encompassing 80 % isodose line for central ly located tumours . Results : Mean follow-up was 13.8 months ( range 1–41 months ) . Until now 6 patients developed a local recurrence , 2 of them in combination with mediastinal lymph node failure . The 1-year actuarial local control rate was 93 % and overall survival 79 % . Pneumonitis was seen in 14 patients ( 21.5 % ) ( Common Terminology Criteria for Adverse Events ( CTCAE ) grade I : n = 12 , and II : n = 2 ) after a median time period of 9.5 months . No patient developed pneumonitis of CTCAE grade III or higher . Conclusion : Image-guided hfSRT  is effective and feasible in patients with non-operable NSCLC , even in higher stages , whenever local control is crucial and there are contraindications against systemic therapy PURPOSE To evaluate mediastinal nodal clearance ( MNC ) rates after induction chemotherapy and concurrent , full-dose radiation therapy ( RT ) in a phase II trimodality trial ( Radiation Therapy Oncology Group protocol 0229 ) . PATIENTS AND METHODS Patients ( n=57 ) with stage III non-small cell lung cancer ( pathologically proven N2 or N3 ) were eligible .  Induction chemotherapy consisted of weekly carboplatin ( AUC = 2.0 ) and paclitaxel 50 mg/m(2 ) . Concurrent RT was prescribed , with 50.4 Gy to the mediastinum and primary tumor and a boost of 10.8 Gy to all gross disease . The mediastinum was pathologically reassessed after completion of chemoradiation . The primary endpoint of the study was MNC , with secondary endpoints of 2-year overall survival and postoperative morbidity/mortality . RESULTS The grade 3/4 toxicities included hematologic 35 % , gastrointestinal 14 % , and pulmonary 23 % . Forty-three patients ( 75 % ) were evaluable for the primary endpoint . Twenty-seven patients achieved the primary endpoint of MNC ( 63 % ) . Thirty-seven patients underwent resection . There was a 14 % incidence of grade 3 postoperative pulmonary complications and 1 30-day , postoperative grade 5 toxicity ( 3 % ) . With a median follow-up of 24 months for all patients , the 2-year overall survival rate was 54 % , and the 2-year progression-free survival rate was 33 % . The 2-year overall survival rate was 75 % for those who achieved nodal clearance , 52 % for those with residual nodal disease , and 23 % for those who were not evaluable for the primary endpoint ( P=.0002 ) . CONCLUSIONS This multi-institutional trial confirms the ability of neoadjuvant concurrent chemoradiation with full-dose RT to sterilize known mediastinal nodal disease The optimal integration of radiation and chemotherapy for limited-stage small-cell lung cancer ( SCLC ) remains unclear . This phase III trial was conducted to determine whether chemotherapy plus interdigitating split-course thoracic radiation therapy ( RT ) improved survival compared with st and ard-dose continuous thoracic RT . One hundred fourteen patients were r and omized to receive 50 Gy thoracic RT  delivered in 2.0-Gy fractions given continuously ( 5 weeks ) concurrent with the first 2 cycles of chemotherapy ( arm A ) or 50 Gy  delivered via an interdigitating split course in 2.5-Gy fractions ( 8 weeks ) concurrent with the first 3 cycles of chemotherapy ( arm B ) . During the split-course RT , once-daily radiation was delivered on days 8 - 17 of each of the first two 21-day cycles and days 8 - 11 of the third 21-day cycle . All patients received the following chemotherapy : cisplatin/etoposide on cycles 1 , 2 , and 5 and cyclophosphamide/vincristine/doxorubicin on cycles 3 , 4 , and 6 . Prophylactic cranial irradiation was recommended after a complete response to all therapy . One hundred ten eligible patients were r and omized .  Grade 3/4 esophagitis was reported in 9 % of patients receiving continuous thoracic RT versus 4 % of patients receiving split-course RT . Grade 3/4 hematologic toxicity was common in both treatment arms . Complete/partial response was observed in 80 % of patients on arm A versus 84 % on arm B. Overall survival rates at 5 years were 18 % and 17 % for arms A and B , respectively . Interdigitating split-course thoracic RT delivered in 2.5-Gy fractions was tolerable in patients with limited-stage SCLC but did not provide a survival advantage BACKGROUND To optimize palliation in incurable locally advanced non-small cell lung cancer ( NSCLC ) , the International Atomic Energy Agency conducted a prospect i ve r and omized study ( NCT00864331 ) comparing protracted palliative radiotherapy ( RT ) course with chemotherapy ( CHT ) followed by short-course palliative RT . METHODS AND MATERIAL S Treatment-naive patients with histologically confirmed NSCLC , stage IIIA/IIIB , received either 39Gy in 13 fractions as RT alone ( arm A , n=31 ) or 2 - 3 platinum-based CHT cycles followed by 10Gy in a single fraction or 16Gy in 2 fractions separated by one week ( arm B , n=34 ) . Primary outcome was overall survival . RESULTS Treatment groups were balanced with respect to various variables . Median survival for all 65 patients was 8months , while median survival was 7.1 and 8.1months for the two arms , respectively ( log-rank p=0.4 by study arm , and p=0.6 by Cox regression and stratified by country and sub-stage ) . One and three year survival rates for the two arms were 29 % , and 9 % and 41 % , and 6 % , respectively . There were no differences in any of the following endpoints : any failure , local failure , regional failure , contralateral thoracic failure , and distant failure between the two arms . High- grade ( ⩾3 ) toxicity was similar between the two arms . Symptoms , adverse events of any kind , KPS and body-mass index , were not different during treatment and during follow-up . There was no grade 5 toxicity . CONCLUSIONS This incomplete and underpowered trial only hinted similar outcome between the treatment arms . Therefore , combined CHT-RT can perhaps be considered , in limited re source setting , where access to RT remains inadequate
RESULTS For patients who have undergone surgical resection , high-level evidence suggests that use of postoperative RT does not influence survival , but optimizes local control for patients with N2 involvement , and its use in the setting of positive margins or gross primary /nodal residual disease is recommended .
No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy ; however , modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized .
PURPOSE To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy ( RT ) in locally advanced non-small cell lung cancer ( LA NSCLC ) based on available medical evidence complemented by consensus-based expert opinion .