Concurrent palliative chemoradiation leads to survival and quality of life benefits in poor prognosis stage III non-small-cell lung cancer: a randomised trial by the Norwegian Lung Cancer Study Group

H H Strøm, R M Bremnes, S H Sundstrøm, N Helbekkmo, O Fløtten, U Aasebø, H H Strøm, R M Bremnes, S H Sundstrøm, N Helbekkmo, O Fløtten, U Aasebø

Abstract

Background: The palliative role of chemoradiation in the treatment of patients with locally advanced, inoperable non-small-cell lung cancer stage III and negative prognostic factors remains unresolved.

Methods: Patients not eligible for curative radiotherapy were randomised to receive either chemoradiation or chemotherapy alone. Four courses of intravenous carboplatin on day 1 and oral vinorelbin on days 1 and 8 were given with 3-week intervals. Patients in the chemoradiation arm also received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. The primary end point was overall survival; secondary end points were health-related quality of life (HRQOL) and toxicity.

Results: Enrolment was terminated due to slow accrual after 191 patients from 25 Norwegian hospitals were randomised. Median age was 67 years and 21% had PS 2. In the chemotherapy versus the chemoradiation arm, the median overall survival was 9.7 and 12.6 months, respectively (P<0.01). One-year survival was 34.0% and 53.2% (P<0.01). Following a minor decline during treatment, HRQOL remained unchanged in the chemoradiation arm. The patients in the chemotherapy arm reported gradual deterioration during the subsequent months. In the chemoradiation arm, there were more hospital admissions related to side effects (P<0.05).

Conclusion: Chemoradiation was superior to chemotherapy alone with respect to survival and HRQoL at the expense of more hospital admissions due to toxicity.

Figures

Figure 1
Figure 1
CONSORT flow diagram for the Conrad study.
Figure 2
Figure 2
Kaplan–Meier plots for (A) time to progression and (B) overall survival.
Figure 3
Figure 3
Proportions of health-related quality of life (HRQOL) questionnaires completed at baseline and during the study. The median received/expected proportions were 87.5% in the first 6 months of the study and 72.3% for the last 6 months.
Figure 4
Figure 4
Mean scores and mean change in the selected domains. A higher score for dysphagia indicate more pronounced symptoms, whereas higher score for the three other domains indicate better function.

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