Administering chemotherapy before radiotherapy is linked with increased overall survival for patients with non-small-cell lung cancer (NSCLC) with disease metastasis after undergoing resection. Researchers published their findings online in the Journal of Clinical Oncology (doi: 10.1200/JCO.2017.74.4771).
“Although several feasibility studies have demonstrated the safety of adjuvant concurrent chemoradiotherapy for locally advanced or incompletely resected non-small-cell lung cancer, it remains uncertain whether this approach is superior to sequential chemotherapy followed by postoperative radiotherapy,” researchers wrote. “We sought to determine the most effective treatment sequence.”
The study focused on the overall survival of two cohorts of patients with non-metastatic NSCLC who had undergone a lobectomy followed by multiagent chemotherapy and radiotherapy: 747 patients had R0 resection and pN2 disease, and 277 patients had R1-2 resection regardless of nodal status.
In patients with R0 resection and pN2 disease, the median overall survival was 58.8 months for patients who received chemotherapy followed by postoperative radiotherapy, researchers found. Among those patients who received concurrent chemoradiotherapy, the median overall survival was 40.4 months.
In patients with R1-2 resection regardless of nodal status, the median overall survival was 42.6 months with sequential chemotherapy followed by postoperative radiotherapy compared with 38.5 months with concurrent chemoradiotherapy. After propensity score matching, researchers found no statistical difference in overall survival between the two treatment sequences for patients in the second cohort.
“For patients with positive margins after surgery,” they reported, “there is not a clear association between treatment sequencing and survival.”—Jolynn Tumolo