Concurrent vs. sequential – which is the best chemoradiotherapy strategy for non-small cell lung cancer?

This study investigated if concurrent (cCRT) or sequential chemoradiotherapy (sCRT) was more effective in non-small cell lung cancer (NSCLC).

They found that sCRT was associated with better survival than cCRT.

Non-small cell lung cancer (NSCLC) is a common cancer. It is usually diagnosed at an advanced stage. Standard treatment involves removing solid tumors and chemoradiotherapy (CRT). CRT involves administering both chemotherapy (CT) and performing radiation therapy (RT). Some patients are only treated with radiation. There are two strategies for delivering CRT in NSCLC. 

Sequential CRT (sCRT) involves first administering CT. Once completed, RT is performed. The reverse is also used in sCRT (RT then CT). The second approach is concurrent CRT (cCRT). CT and RT are administered during the same treatment period. There are benefits and risks with both approaches. Some studies suggest cCRT may improve survival. cCRT is associated with a high rate of toxicity. sCRT is usually better tolerated. It is unclear if sCRT or cCRT is more effective in NSCLC. 

This study included 1924 patients with NSCLC. 1115 underwent sCRT and 809 underwent cCRT. Survival was the main outcome of interest. The average follow-up for patients was 32 months. 

Most patients in the sCRT group received CT first (93%). Survival rates were significantly higher in sCRT patients. The average survival in sCRT patients was 53 months. This compares to an average survival of 37 months in cCRT patients. 

The authors concluded that sCRT was associated with better survival than cCRT in patients with NSCLC.

Data on CT regimens or RT protocols were not available. This is important as it can have an impact on adverse effects or toxicities. The database did not record toxicities in these patients so we cannot conclude if sCRT is better tolerated. More investigation is needed.