Cancer Research Lab

Following induction chemotherapy for patients with stage IIIA-N2 non-small-cell lung cancer, radiation therapy rather than surgery should be considered the preferred locoregional treatment, according to investigators in Europe.

Dr. Jan P. van Meerbeeck, from University Hospital Ghent in Belgium, and his associates studied 332 patients with stage IIIA-N2 cancer who responded to three cycles of platinum-based chemotherapy. Patients were randomly assigned to radiotherapy (n = 165) or to surgery (n = 167).

Subjects were registered between 1994 and 2002 from 41 institutions in Europe; median follow-up was approximately 6 years. The results are published in the Journal of the National Cancer Institute for March 21.

Median survival was 17.5 months in the radiotherapy arm and 16.4 months in the surgery arm. Progression-free survival was 11.3 months and 9 months, respectively. The differences were not statistically significant.

Dr. van Meerbeeck’s group points out that surgery is of dubious value when mediastinal involvement persists after induction chemotherapy, and that the likelihood of survival is reduced if resection is incomplete.

They conclude that “in view of its low morbidity and mortality, radiotherapy is to be considered the preferred locoregional treatment” for patients with stage IIIA-N2 non-small-cell lung cancer.

In a related editorial, Dr. David H. Johnson, from Vanderbilt University School of Medicine in Nashville, Tennessee, and associates don’t totally agree, noting that some of these patients “may still be appropriately managed by resection rather than radiation.” They base this on the trial finding that local control was better in the surgical arm.

Moreover, they add, “careful interdisciplinary planning of patient care at the time of diagnosis to optimize selection of the local control modality is essential to achieving the best outcome in this patient population.”