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Phase II Trial of Postoperative Adjuvant Paclitaxel/Carboplatin and Thoracic Radiotherapy in Resected Stage II and IIIA Non–Small-Cell Lung Cancer: Promising Long-Term Results of the Radiation Therapy Oncology Group—RTOG 9705

From the Washington University, St Louis; Phelps County Regional Medical Center, Rolla, MO; Radiation Therapy Oncology Group; University of Pennsylvania Hospital; Thomas Jefferson University Hospital, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; University of Rochester, Rochester, NY; UCLA Medical Center, Los Angeles, CA; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Southeast Cancer Control Consortium, Winston Salem, NC

Address reprint requests to Jeffrey D. Bradley, MD, Department of Radiation Oncology, Washington University Medical Center, 4921 Parkview Place–LL, Mail Stop 90-38-635, St Louis, MO 63110; e-mail: Bradley{at}radonc.wustl.edu

PURPOSE: To determine the overall survival, progression-free survival, and toxicity associated with concurrent paclitaxel/carboplatin and thoracic radiotherapy for completely resected patients with stage II and IIIA non–small-cell lung cancer (NSCLC).

PATIENTS AND METHODS: Eighty-eight eligible patients had surgical resection for pathologic stage II or IIIA disease and received postoperative paclitaxel and carboplatin. Concurrent thoracic radiotherapy at 50.4 Gy in 28 fractions for 6 weeks (1.8 Gy/d, 5 days/wk) was given during cycles 1 and 2. A boost of 10.8 Gy in six fractions was given for extracapsular nodal extension or T3 lesions.

RESULTS: Treatment compliance was acceptable, with 93% compliance for radiation therapy and 86% for chemotherapy completion. The median duration of follow-up was 56.7 months (range, 17 to 61 months). The median overall survival time was 56.3 months, with 1-, 2-, and 3-year survival rates of 86%, 70%, and 61%, respectively. The 1-, 2-, and 3- year progression-free survival rates were 70%, 57%, and 50%, respectively. Brain metastasis occurred as the sole site of first failure in 11%, and 9% failed in other metastatic sites as first failure. Of the 43 patients who died, the cause of death was the treated cancer in 31 (35%). Local failure was a component of first failure in 15% of patients. Toxicities were acceptable. An overall survival comparison to Eastern Cooperative Oncology Group 3590 is favorable.

CONCLUSION: The mature results of this trial suggest an improved overall and progression-free survival in this group of resected NSCLC patients, compared with previously reported trials. A phase III trial comparing this treatment regimen with standard therapy seems warranted.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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