Post-Rx surgery won’t boost OS in lung cancer

Performing surgery following concurrent chemotherapy and radiotherapy for patients with stage IIIA (N2) non-small-cell lung cancer does not lead to better overall survival rates than chemotherapy and radiotherapy alone, according to an RTOG trial (The Lancet online, July 27, 2009).

RTOG 9309 enrolled 202 patients who were randomly assigned to two cycles of cisplatin (50 mg/m² on days one, eight, 29, and 36) and etoposide (50 mg/m² on days one to five and 29–33) plus radiotherapy (45 Gy). If there was no progression, patients in group one underwent surgery and those in group two continued radiotherapy uninterrupted up to 61 Gy. Two additional cycles of cisplatin and etoposide were given in both groups.

According to the results, median overall survival (OS) was 23.6 months in group one vs 22.2 months in group two.The five-year survival rate was 27% for group one and 20% for group two. Progression-free survival (PFS) was significantly better in group one than in group two (median 12.8 months vs 10.5 months). The PFS rate at five years for group one was 22% and 11% for group two.

The authors, including principal investigator Kathy Albain, MD, suggested that the reason for an absence of effect of surgery could be inadequate power in the trial, or reduced delivery of later chemotherapy (cycles 3 and 4) in the surgery group.

They added that the most likely reason was increased mortality following pneumonectomy, mainly due to acute respiratory distress syndrome and other respiratory causes.