Update: December 2013

Recommendation: The value of radical radiotherapy alone in unresectable Stage III NSCLC is questionable. Local therapy alone rarely results in a 5 year survival greater than 5% and thus in most instances is palliative in intent. There may be an increased likelihood of local control with the use of higher radiation doses.

Discussion:

Patients with good performance status and minimal weight loss who decline or are unsuitable for combined modality/altered fractionation schemes and whose disease can be readily encompassed in a reasonable radiotherapy volume may be candidates for radical radiotherapy.

The use of radical radiotherapy alone in unresectable Stage III disease is controversial. Radical radiotherapy alone using conventional fractionation (2 Gy or equivalent to a total dose of 60 Gy) has been associated with a median survival of 9 – 12 months and 5-year survival of 5 percent. This is not markedly different from that observed with the use of palliative radiotherapy alone in the BCCA experience. Radiation may help with symptoms related to local tumour and control of local tumour growth.

References:

1. Dillman RO, Herndon J, Seagren SL, Eaton WL Jr, Green MR. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial J Natl Cancer Inst. 1996;88(17):1210.

2. Sause WT, Scott C, Taylor S, Johnson et. al. Radiation Therapy Oncology Group (RTOG) 88-08 and Eastern Cooperative Oncology Group (ECOG) 4588: preliminary results of a phase III trial in regionally advanced, unresectable non-small-cell lung cancer. J Natl Cancer Inst. 1995;87(3):198

3. Johnson DH, Einhorn LH, Bartolucci A, Birch R, Omura G, Perez CA, Greco FA. Thoracic radiotherapy does not prolong survival in patients with locally advanced, unresectable non-small cell lung cancer. Ann Intern Med. 1990;113(1):33.