Stage 3 non–small-cell lung cancer: Radiotherapy and chemotherapy

Researchers in North America have compared the results of radiotherapy plus chemotherapy with or without surgical resection in patients with stage 3 non– small-cell lung cancer.

A total of 396 patients were randomized to surgery or no surgery (but extra radiotherapy). There was no significant difference in overall survival (23.6 months with surgery, 22.2 months without). Five-year survival was 27% versus 20%. Progression-free survival was better in the surgical group (median 12.8 months versus 10.5 months). The main toxic effects of chemotherapy and radiotherapy were neutropenia and oesophagitis. Treatment-related mortality was 8% (surgery) versus 2% (no surgery). Among surgical patients, lobectomy gave better results than pneumonectomy.

These researchers conclude that both surgical and non-surgical treatments are valid options.

Albain KS, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 2009;374:379–386; Eberhardt WEE, et al. Surgery in stage III non-small-cell lung cancer. Ibid:359–360 (comment).