Combining radiation with chemotherapy to treat advanced NSCLC that has spread around the body

This study examined whether patients with non-small-cell lung cancer that has spread to multiple sites in the body may benefit from radiation combined with chemotherapy. The authors of this trial concluded that for patients with high tumor volume, high dose radiation with effective chemotherapy could benefit. 

In stage IV non-small-cell lung cancer, the cancer has spread to other areas of the body (metastatic). It is usually treated with chemotherapy, but is associated with low survival rates. It is possible that combining radiation with chemotherapy may be beneficial for these patients.

There are two types of metastatic disease. Oligometastatic means the cancer has spread to a limited amount of areas in the body. Non-oligometastatic means it has spread to multiple other body sites. The combination of radiation and chemotherapy has been beneficial for patients with oligometastatic lung cancers. It is unknown whether it would be effective for patients with non-oligometastatic NSCLC.

This trial looked at whether combining chemotherapy with radiation would be effective for patients with stage IV NSCLC. 274 patients who took part in two other studies were included. 91 of these had oligometastatic disease (less than 5 metastases). 183 patients had non-oligometastatic disease (5 or more metastases).

Overall survival (time from beginning trial until death) was higher for those who had high level radiation. For these patients, average OS at 1 year was 55.3% and 17% at 3 years.

For patients with oligometastatic disease, 1 year OS was 59.3% and 15.2% at 3 years. Of these patients, OS was better for those who had a higher dose of radiation and a higher initial tumor volume.

For patients with non-oligometastatic disease, 1 year OS was 46.4% and 6% at 3 years. Of these, OS was better for patients who received a higher radiation dose, had a higher initial tumor volume, better health scores after treatment and responded to chemotherapy.

The authors concluded that high dose radiation combined with effective chemotherapy could be beneficial for patients with non-oligometastatic NSCLC for patients with a high tumor volume.

This study did not outline side effects that may come from including high dose radiation with treatment.