No Survival Advantage for High-Dose Radiation Versus Standard-Dose Radiation in Stage III NSCLC
Published Online: Wednesday, January 11, 2012
Jeffrey D. Bradley, MD
“This was the first study in 30 years to see if a higher dose of radiation would have a survival benefit, and radiation techniques have improved significantly over that time,” said Jeffrey D. Bradley, MD, Washington University in St. Louis, Missouri. “There was no benefit for 74 Gy over 60 Gy, and the 74-Gy-dose arms were closed in June 2011. The 60-Gy dose should remain the accepted standard,” he stated.
The ongoing phase III trial plans to enroll 500 patients with stage III NSCLC; at the time of the interim analysis, enrollment was up to 423 patients. Patients were randomized to 4 arms: standard-dose radiation (60 Gy) plus chemotherapy (paclitaxel/ carboplatin) and cetuximab; standard-dose radiation with chemotherapy and no cetuximab; high-dose radiation (74 Gy) with chemotherapy plus cetuximab; and high-dose radiation with chemotherapy and no cetuximab. The second question the study is exploring is whether cetuximab provides added benefit over radiation and chemotherapy in this setting. That part of the trial is still open.
“This was the first study in 30 years to see if a higher dose of radiation would have a survival benefit, and radiation techniques have improved significantly over that time. ”
–Jeffrey D. Bradley, MD
According to multivariate analysis, factors that contributed to worse survival were radiation dose, nonsquamous histology, and smaller tumor volume.
Speculating on why high-dose radiation did not improve survival, Bradley said that distant metastases pose a significant challenge in patients with lung cancer, and that radiation addresses local control, but not systemic control.
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