The CancerWeb Report, What's New In Cancer: September, 1996
Lung Cancer

• Update on survival of lung cancer patients treated with chemotherapy before radiation - The September 4, 1996 issue of the Journal of the National Cancer Institute contained an update on a clinical trial performed between 1984 and 1987 by the Cancer and Leukemia Group B. The patients in this study had advanced Stage III non-small-cell lung cancer. After more than 7 years of follow-up, survival rates for the patients treated with chemotherapy (5 weeks of cisplatin and vinblastine) before radiotherapy remained better than for those receiving radiation alone. The median survival was 13.7 months for the combination and 9.6 months for the radiation only group. Survival rates at 5 and 7 years, respectively, were 17% and 13% for combined treatment, versus 6% and 6% for radiation alone. (Dillman, J Natl Cancer Inst 88:1210, 1996)

  Editor's Comment: - Although the improvement achieved with preirradiation chemotherapy looked impressive, we should not forget that over 80% of patients died within 5 years, so that the need for more effective treatment of this disease remains urgent.

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• Post-operative radiation for lung cancer, still doubt whether it is of significant benefit - Four randomized trials of post-operative radiotherapy in patients treated surgically for non-small-cell lung cancer have failed to demonstrate benefit; another trial by the European Organization for Research and Treatment of Cancer showed significant benefit (70% versus 50% 3-year survival). These trials have generally lacked sufficient size for statistical demonstration of improved survival, and too many patients were excluded from the final analysis. The issue is important, due to the widespread occurrence and seriousness of this disease, and because patients should never be subjected to ineffective treatment. A sixth study of 308 patients from 16 centers in the UK, coordinated by the Medical Research Council, was published in the August issue of the British Journal of Cancer. It failed to find any evidence for benefit from radiotherapy in patients with disease staged as N1 (metastases to lymph nodes around the bronchial area). For those staged as N2 (with metastases to the lymph nodes in the central back area - the mediastinum), addition of radiotherapy produced clinically significant reduction in metastases, but longer follow-up will be needed to determine whether the apparent increase of about one month in survival time for these patients holds up. (Stephens, Brit J Cancer 74:632, 1996)

  Editor's Comment: - Unfortunately, although the results of this trial are suggestive, the number of patients was not sufficient to provide statistical proof of improved survival in the various subgroups. Several thousand patients would be required for this. It is also possible, as discussed in an editorial on the subject in the same journal issue, that the radiation dose or schedule needs adjustment in future studies for improved efficacy.