Can we optimize chemo-radiation and surgery in locally advanced stage III non-small cell lung cancer based on evidence from randomized clinical trials? A hypothesis-generating study

Purpose. Improved local tumor control (LC) improves survival of patients with non-small cell lung cancel (NSCLC). We estimated the capability of surgical and non-surgical options to improve LC further in this disease. Methods Eligible studies were phase III trials reporting 2-year survival data as well as the incidence of LC and/or distant metastases Effect estimates. as well as the statistical uncertainty of these, were combined in circlet to estimate the benefit in terms of LC from combining multiple modalities Results It was estimated that the highest rates of LC can be obtained with high-dose concurrent chemoradiation followed by surgery. In this situation. escalating the pre-operative radiation close from 45 to 66 Gy, delivered concurrently with chemotherapy, could increase LC from 58% to 76% Toxicity may also be higher, but could not be estimated Without surgery. the gain in LC from concurrent chemo-radiation versus sequential, corresponds to a radiation dose increase from 65 to 72 Gy Conclusions: We hypothesize that high-dose concurrent chemo-radiation followed by surgery Could be superior to other current treatment approaches for selected patients with stage III NSCLC, provided toxicity would be low At present, high-dose concurrent chemo-radiation followed by surgery should be considered experimental (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 93 (2009) 389-395