Radiotherapy Better than Surgery for Some Lung Cancer Patients

The researchers who performed the study suggest that a combination of chemotherapy and radiation should be the preferred treatment option for these patients.

About 80% of all lung cancers are non-small-cell lung cancers (NSCLCs), and of those patients diagnosed with NSCLC, approximately 30% have locally advanced stages IIIA or IIIB. Earlier research had shown that treating stage IIIA patients with chemotherapy before surgery increases the survival rate compared with patients receiving only surgery. The researchers had originally theorized that surgery would be more effective than radiation after chemotherapy treatment.

Jan van Meerbeeck, M.D., Ph.D., from the University Hospital of Ghent (Belgium) and colleagues from the European Organization for Research and Treatment of Cancer (EORTC) recruited 579 eligible patients from 41 institutions into the trial between December 1994 and December 2002. All of the patients were diagnosed with stage IIIA-N2 NSCLC that had progressed so far that it could not be completely removed by surgery.

The patients were first given three cycles of platinum-based chemotherapy. Those who responded to the treatment--61% of the initial group--were then randomly assigned to receive surgery or radiation, 167 and 165 patients, respectively.

The investigators discovered that surgery, compared to radiation, did not improve survival after treatment with chemotherapy. The median survival time for surgical patients was 16.4 months vs 17.5 months for patients who were treated with radiation. The five-year overall survival rate for surgical patients was 15.7%, compared with 14% for patients who received radiation. Although the survival rates for the two groups were very similar, the researchers concluded that radiation was the preferred treatment because of its lower rate of complications and mortality in lung cancer patients.

"These results are important because several centers routinely use…chemotherapy followed by surgery to treat patients with this stage of disease based on small randomized studies that showed that surgery alone is inferior to…chemotherapy and surgery in stage IIIA patients,” the authors wrote in their article.


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