Palliative Thoracic EBRT With Concurrent Chemotherapy Is an Option for Incurable NSCLC

Jason Harris
Published: Monday, Jul 23, 2018
Benjamin J. Moeller, MD, PhD

Benjamin J. Moeller, MD, PhD

Although few clinical trials have addressed the use of concurrent chemotherapy (CC) with thoracic external beam radiation therapy (EBRT) in non–small cell lung cancer (NSCLC), a review of available evidence has led the American Society for Radiation Oncology (ASTRO) to issue a strong recommendation for use of CC with EBRT in a subset of patients with incurable stage III NSCLC.1 However, ASTRO refrained from recommending the use of CC with EBRT in stage IV NSCLC, owing to a lack of clinical studies of its value.

The authors of the current guideline say the prior findings were limited because eligibility was poorly defined and because the Ball investigators used 5-fluorouracil alone as the chemotherapy agent. Subsequent research has established platinum-containing chemotherapy as the superior choice for treating NSCLC.

Table. Guidelines for Concurrent Chemotherapy With Palliative Thoracic EBRT

Table. Guidelines for Conurrent Chemotherapy With Palliative Thoracic EBRT

ECOG indicates Eastern Cooperative Oncology Group; EBRT, external beam radiation therapy; NSCLC, non–small cell lung cancer; PS, performance score.
Since the original guidelines were published, 2 studies of note have emerged that the guideline authors said were key to their updated recommendations. In the first, a phase II study by Nawrocki et al, 99 patients with incurable stage III NSCLC were randomly assigned 1:1 to either 3000 cGy administered in 10 fractions or the same radiation dose delivered concurrently with the third of 3 cycles of 80 mg/m2 of cisplatin on day 1 and 25 mg/m2 of vinorelbine (Navelbine) on days 1 and 8. Eligible patients had an ECOG performance status of 0 to 2.4
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