Sequential chemoradiotherapy versus radiotherapy in the management of locally advanced non-small-cell lung cancer

This prospective randomized trial compared neoadjuvant chemotherapy followed by local-regional radiotherapy (study group) with radiotherapy alone (control group) in 506 patients with locally advanced non-small-cell lung cancer. The study group received three cycles of cisplatin, ifosfamide with Mesna, and mitomycin C at 21-day intervals. Radiotherapy was delivered up to a dose of 60 Gy. Evaluable patients numbered 460. In the study group, 228 patients were assessed for tumor response after chemotherapy: 13 (5.7%) had a complete response; 103 (43.2%), a partial response; 48 (21%) showed no change; and 74 patients (31.1%) had progressive disease. These patients then received chest irradiation, which was well tolerated. On completion of radiotherapy, 16.2% of the study group and 6% of the control group had a complete response. No change was seen in 10.1% of study patients and 15.5% of control patients. Respective rates for disease progression were 27.6% and 42.3%. Actuarial 2-year survival was 20% in the study group and 7.4% in the control group.