Journal of Clinical Oncology, Vol 13, 452-458, Copyright © 1995 by American Society of Clinical Oncology
Randomized trial of hyperfractionated radiation therapy with or without concurrent chemotherapy for stage III non-small-cell lung cancer
B Jeremic, Y Shibamoto, L Acimovic and L Djuric
Department of Oncology, University Hospital, Kragujevac, Yugoslavia.
PURPOSE: To investigate the efficacy of combined hyperfractionated
radiation therapy (HFX RT) and concurrent chemotherapy (CHT) in stage IIIA
or IIIB non-small-cell lung cancer (NSCLC) compared with that of HFX RT
alone. PATIENTS AND METHODS: Between January 1988 and December 1989, 169
patients were divided randomly into the following groups: group I, HFX RT
with 1.2 Gy twice daily to a total dose of 64.8 Gy (n = 61); group II, same
HFX RT with CHT consisting of 100 mg of carboplatin (CBDCA) on days 1 and 2
and 100 mg of etoposide (VP-16) on days 1 to 3 of each week during the RT
course (n = 52); and group III, same HFX RT with CHT consisting of 200 mg
of CBDCA on days 1 and 2 and 100 mg of VP- 16 on days 1 to 5 of the first,
third, and fifth weeks of the RT course (n = 56). RESULTS: The median
survival time (MST) was 8 months for group I, 18 months for group II, and
13 months for group III. The 3- year survival rates were 6.6%, 23%, and
16%, respectively. There was a significant difference in the survival rate
between groups I and II (P = .0027, log-rank test), but not between groups
I and III (P = .17) or between groups II and III (P = .14). The
relapse-free survival rate in group II was also higher than that in group I
(P = .0024), which was largely due to improved local control in group II
patients. Patients in groups II and III showed a higher incidence of acute
and/or late high- grade toxicity compared with group I patients, but no
patient died of treatment-related toxicity. CONCLUSION: The combination of
HFX RT and continuous CBDCA/VP-16 CHT was tolerable and substantially
increased the survival rate.
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