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Adjuvant radiotherapy versus combined sequential chemotherapy followed by radiotherapy in the treatment of resected nonsmall cell lung carcinoma. A randomized trial of 267 patients
Author(s) -
Dautzenberg Bertrand,
Chastang Claude,
Arriagada Rodrigo,
Chevalier Thierry Le,
Belpomme Dominique,
Hurdebourcq Michel,
Lebeau Bernard,
Fabre Christiane,
Charvolin Patrick,
Guérin Robert A.
Publication year - 1995
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19950901)76:5<779::aid-cncr2820760511>3.0.co;2-o
Subject(s) - medicine , radiation therapy , vincristine , lomustine , chemotherapy , oncology , stage (stratigraphy) , adenocarcinoma , lung cancer , carcinoma , randomized controlled trial , surgery , cancer , cyclophosphamide , paleontology , biology
Background . The effect of adjuvant chemotherapy after resection of nonsmall cell lung cancer (NSCLC) remains an unresolved question. Methods . From October, 1982, to November, 1986, 267 patients with resected NSCLC were included in a randomized trial. The adjuvant allocated treatments were either postoperative radiotherapy, 60 Gy in 6 weeks (radiotherapy group = 129 patients), or three courses of postoperative COPAC (cyclophosphamide, doxorubicin, cisplatin, vincristine, lomustine) chemotherapy followed by a similar radiotherapy schedule (chemotherapy/radiotherapy group = 138 patients). Results . The sex ratio (M:F) was 19/1; mean age was 57 ± 9 years. According to postoperative staging, 8 patients were Stage I, 70 were Stage II, and 189 were Stage III. The histologic type was squamous cell carcinoma in 175 patients, adenocarcinoma in 57, and large cell carcinoma in 35. The minimum follow‐up was 6 years. Four patients were lost to follow‐up. Death was recorded in 233 patients. No significant difference was observed in terms of disease free interval ( P = 0.47, log‐rank test), or overall survival ( P = 0.68, log‐rank test). With respect to the first site of relapse, distant metastasis occurred more frequently in the radiotherapy group ( P = 0.09, log‐rank test) whereas local relapse occurred similarly in both groups ( P = 0.27). An interaction was observed between lymph node involvement and treatment in terms of overall survival. Conclusions . The COPAC chemotherapy as postoperative treatment failed to improve overall survival in patients with resected NSCLC receiving postoperative radiotherapy but decreased the pattern of metastatic progression, mainly in the N2 patients.