Updated February 2008
Curative radiotherapy to the primary tumour and involved mediastinal lymph nodes should be integrated with the appropriate chemotherapy regimen for appropriate patients for an additional survival benefit when compared to radical radiotherapy alone in patients with non-small cell lung cancer or chemotherapy alone in patients with small cell lung cancer.
Concurrent chemoradiation has been shown to be superior to sequential chemoradiation in 2 randomised studies. For patients with non-small cell lung cancer, thoracic irradiation and chemotherapy (cisplatin plus etoposide) should begin together starting on day 1. For patients receiving preoperative chemoradiation, the thoracic irradiation dose is 45 Gy in five weeks. For definitive chemoradiation (without surgical resection), the thoracic irradiation dose should be at least 60 Gy. For patients receiving chemoradiotherapy for limited stage small cell lung cancer, radiotherapy may start with day 1 of either cycle 1 or 2. The total dose is 40 Gy/15 fractions in 3 weeks for patients with small cell lung cancer.
For patients who are not eligible for concurrent chemoradiotherapy, but are thought to be eligible for sequential chemoradiotherapy, e.g. either due to decrease patient performance status or very large lung cancers that are not easily treated with radiotherapy initially, thoracic radiotherapy can be given after completion of chemotherapy in a sequential fashion. The dose is similar to that given with concurrent chemoradiotherapy.
For all patients, these doses may need to be modified due to poor underlying pulmonary function, and total volume of lung that needs to be irradiated.
References:
Furuse K, Fukuoka M, Kawahara M, et al: Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. JCO 17:2692-9, 1999
Le Chevalier T, Arriagada R, Quoix E, et al. Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: first analysis of a randomized trial in 353 patients. J Natl Cancer Inst. 1991 Mar 20;83(6):417-23.
Dillman RO, Herndon J, Seagren SL, et al: 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 88:1210-5, 1996
K. S. Albain, R. S. Swann, V. R. Rusch et al. Phase III study of concurrent chemotherapy and radiotherapy (CT/RT) vs CT/RT followed by surgical resection for stage IIIA(pN2) non-small cell lung cancer (NSCLC): Outcomes update of North American Intergroup 0139 (RTOG 9309). ASCO 2005: 7014
Pfister DG, Johnson DH, Azzoli CG, et al: American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: update 2003. JCO 22:330-53, 2004
