Adding chemotherapy to radiation therapy does not prolong survival in operable, non-small-cell lung cancer, according to a large, randomized study that compared the
chemotherapy/radiation combination to radiation alone. The new findings appear in the Oct. 26
issue of the New England Journal of Medicine.
Led by Steven Keller at Beth Israel Medical Center in New York, the trial enrolled 488
patients whose disease had spread to, but not beyond, nearby lymph nodes. All had undergone
surgery in which any visible tumor was completely removed. The patients were divided into two
groups: One group received the chemotherapy drugs cisplatin and etoposide concurrently with
radiation therapy, while the other received radiation alone.
Patients receiving the combined treatment had a median survival of 38 months compared
to 39 months among those receiving radiation alone. Overall survival and recurrence rates were
also similar in the two groups.
The study is the latest of many that have looked at post-surgical, or adjuvant,
chemotherapy in non-small-cell lung cancer, according to an accompanying editorial by
Desmond N. Carney, M.D., at Mater Hospital in Dublin, Ireland, and Heine H. Hansen of the
Finsen Center in Copenhagen, Denmark. They say that most of these trials have shown no
benefit with chemotherapy and conclude that adjuvant chemotherapy in patients with tumors that
have been completely removed "should not be considered standard care."
However, other and newer kinds of presurgical and post-surgical chemotherapy are now
in clinical trials and may prove to be of benefit. Participation in these trials remains an important
option for patients and "should be encouraged," say Carney and Hansen, "so that real progress
can be made against non-small-cell lung cancer."