RESULTS For patients who have undergone surgical resection , high-level evidence suggests that use of postoperative RT does not influence survival , but optimizes local control for patients with N2 involvement , and its use in the setting of positive margins or gross primary /nodal residual disease is recommended .
No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy ; however , modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized .
PURPOSE To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy ( RT ) in locally advanced non-small cell lung cancer ( LA NSCLC ) based on available medical evidence complemented by consensus-based expert opinion .
Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer.
BACKGROUND We undertook to determine whether adjuvant vinorelbine plus cisplatin prolongs overall survival among patients with completely resected early-stage non-small-cell lung cancer . METHODS We r and omly assigned patients with completely resected stage IB or stage II non-small-cell lung cancer to vinorelbine plus cisplatin or to observation . The primary end point was overall survival ; principal secondary end points were recurrence-free survival and the toxicity and safety of the regimen . RESULTS A total of 482 patients underwent r and omization to vinorelbine plus cisplatin ( 242 patients ) or observation ( 240 ) ; 45 percent of the patients had pathological stage IB disease and 55 percent had stage II , and all had an Eastern Cooperative Oncology Group performance status score of 0 or 1 . In both groups , the median age was 61 years , 65 percent were men , and 53 percent had adenocarcinomas . Chemotherapy caused neutropenia in 88 percent of patients ( including grade 3 febrile neutropenia in 7 percent ) and death from toxic effects in two patients ( 0.8 percent ) . Nonhematologic toxic effects of chemotherapy were fatigue ( 81 percent of patients ) , nausea ( 80 percent ) , anorexia ( 55 percent ) , vomiting ( 48 percent ) , neuropathy ( 48 percent ) , and constipation ( 47 percent ) , but severe ( grade 3 or greater ) toxic effects were uncommon ( < 10 percent ) . Overall survival was significantly prolonged in the chemotherapy group as compared with the observation group ( 94 vs. 73 months ; hazard ratio for death , 0.69 ; P=0.04 ) , as was relapse-free survival ( not reached vs. 46.7 months ; hazard ratio for recurrence , 0.60 ; P<0.001 ) . Five-year survival rates were 69 percent and 54 percent , respectively ( P=0.03 ) . CONCLUSIONS Adjuvant vinorelbine plus cisplatin has an acceptable level of toxicity and prolongs disease-free and overall survival among patients with completely resected early-stage non-small-cell lung cancer
RESULTS For patients who have undergone surgical resection , high-level evidence suggests that use of postoperative RT does not influence survival , but optimizes local control for patients with N2 involvement , and its use in the setting of positive margins or gross primary /nodal residual disease is recommended .
No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy ; however , modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized .
PURPOSE To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy ( RT ) in locally advanced non-small cell lung cancer ( LA NSCLC ) based on available medical evidence complemented by consensus-based expert opinion .