Chemoradiotherapy versus radiation only – which is more effective in inoperable lung cancer?

This study investigated the effectiveness of radiation therapy (RT) and chemoradiotherapy (CRT) in inoperable non-small cell lung cancer (NSCLC).

They found that CRT was more effective than RT alone in these patients. 

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer (LC). Approximately 33% of NSCLC patients have inoperable tumors. It can be very difficult to treat this type of NSCLC. Radiation therapy or radiotherapy (RT) was first used to treat advanced NSCLC. However, some studies suggested chemotherapy (CT) may improve survival in combination with RT. Concurrent CT and RT is now the standard of care for NSCLC.

There is some dispute about CT + RT effectiveness in inoperable stage 3 NSCLC. Some clinicians do not agree that there is an increased survival with CT + RT. It is unclear if CT + RT is more effective than RT alone in inoperable NSCLC.

This study included analyzed data from 13 clinical trials. This included 1936 patients with inoperable stage III NSCLC. Patients in these studies underwent either RT alone or CT + RT. Overall survival (OS) and progression-free survival (PFS) were the main outcomes of interest. Overall response rate (ORR) to treatment was also analyzed. These outcomes were compared between CT + RT and RT alone. 

975 patients received RT alone. 961 patients received CT + RT. OS was 33% higher after 1 year and 43% higher after 2 years for CT + RT-treated patients. PFS was 64% higher after 1 year and 62% higher after 2 years in the CT + RT group. The ORR was slightly higher (by 12%) in the CT + RT group compared to RT alone.

The authors concluded that CT + RT was more effective than RT alone in treating inoperable NSCLC.

The quality of this analysis was moderate. Different types of CT and RT were used in the studies. This can make it difficult to compare results. The findings of this analysis may not be applicable to patients over 70 years of age.