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
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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