Higher-Dose Radiation Does Not Improve Survival in Some Lung Cancer Patients || NCI Cancer Bulletin for October 18, 2011 - National Cancer Institute

 

Higher-Dose Radiation Does Not Improve Survival in Some Lung Cancer Patients

A higher dose of radiation therapy does not improve survival in patients with stage III non-small cell lung cancer (NSCLC) who are not candidates for surgery, researchers reported last week. The findings come from an interim analysis of a phase III randomized clinical trial presented at the American Society for Radiation Oncology (ASTRO) annual meeting in Miami.

“I think [this] changes practice,” said the trial’s principal investigator, Dr. Jeffrey Bradley of the Washington University School of Medicine, during a news briefing.

The trial, conducted by the NCI-sponsored Radiation Therapy Oncology Group, initially compared a radiation dose of 74 Gy to the standard 60 Gy dose in combination with standard chemotherapy with or without cetuximab (Erbitux). The investigators stopped enrollment in the high-dose radiation arms of the trial in June 2011, after the interim analysis revealed that, based on the number of deaths (90) at that point in the trial, there was no statistical chance that overall survival would be improved in patients treated with the 74 Gy radiation dose.

At the time of the interim analysis, 423 patients were enrolled in the study. There were more deaths related to treatment in the high-dose radiation therapy arms (7 versus 3), but that discrepancy did not account for the lower survival in that patient group, the analysis found.

This trial was the first in three decades to compare different radiation doses in patients with stage III NSCLC that had spread no further than to nearby lymph nodes, Dr. Bradley explained. The trial is continuing with two arms, comparing radiation therapy at 60 Gy and chemotherapy with or without cetuximab.

Although the 60 Gy dose has been considered a standard for patients with stage III lung cancer, Dr. Bradley said, several studies conducted at single institutions had suggested that survival could be improved without additional adverse side effects by using a higher radiation dose. Dr. Tim Williams, a former ASTRO president from Boca Raton Regional Hospital, said the higher dose has been the standard at his hospital for the past 5 years.

The findings, said Dr. Giuseppe Giaccone, chief of the Medical Oncology Branch in NCI's Center for Cancer Research, strongly suggest that high-dose radiation therapy should be abandoned in this patient population.
NCI Cancer Bulletin for October 18, 2011 - National Cancer Institute