Neoadjuvant chemotherapy plus preoperative radiation is as effective for advanced non-small-cell lung cancer as neoadjuvant chemotherapy plus postoperative radiation, with each regimen associated with its own significant toxicity, according to a presentation at the annual meeting of the American Society for Therapeutic Radiology and Oncology.

In one of the largest such phase III trials in Europe, researchers worked with the German Lung Cancer Cooperative Group to enroll 558 patients with stage IIIA and IIIB lung cancer in a randomized trial. Each patient first received three cycles of induction chemotherapy before treatment with preoperative radiation therapy followed by surgery or surgery followed by radiation therapy.

The overall results for both regimens were good, with a three-year survival rate of 26.2 percent for patients in the preoperative radiation group and 24.6 percent for patients in the postoperative radiation group. There was no difference between the two treatments regarding tumor control.

Toxicity was significant with both treatments. Patients in the preoperative radiation group had a higher incidence of grade III esophagitis, whereas the postoperative radiation patients showed a higher incidence of grade III/IV pneumonitis.
“The results of this trial show that neither of the treatment regiments have a clear advantage over the other,” said Christian Ruebe, MD, lead author.