Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer

Abstract

When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationale from two large Phase 3 randomised studies and meta-analyses demonstrating the superiority of cCRT over sequential (sCRT). However, the efficacy of cCRT comes at the cost of increased acute toxicity versus sequential treatment. Currently, there are several documented approaches that are addressing this drawback, which this paper outlines. At the point of diagnosis, a multidisciplinary team (MDT) approach can enable accurate assessment of patients, to determine the optimal treatment strategy to minimise risks. In addition, reviewing the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines can provide clinical oncologists with additional recommendations for outlining target volume and organ-at-risk delineation for standard clinical scenarios in definitive cCRT (and adjuvant radiotherapy). Furthermore, modern advances in radiotherapy treatment planning software and treatment delivery mean that radiation oncologists can safely treat substantially larger lung tumours with higher radiotherapy doses, with greater accuracy, whilst minimising the radiotherapy dose to the surrounding healthy tissues. The combination of these advances in cCRT may assist in creating comprehensive strategies to allow patients to receive potentially curative benefits from treatments such as immunotherapy, as well as minimising treatment-related risks.

Real-World Treatment Patterns and Clinical Outcomes in Patients With Stage III Non-Small-Cell Lung Cancer: Results of KINDLE-Vietnam Cohort

“…The female gender was associated with a significantly lower risk of death in both stage IIIA and IIIB. Several studies have shown the female gender as a good prognostic factor ( 40 , 41 ). However, in one of the studies, no significant difference was found between genders in terms of survival (3-year survival, 29% versus 24%).…”

I-125 seeds with chemotherapy for progressive non-small-cell lung cancer after first-line treatment: a meta-analysis

“…The most (approximate 75–80%) prominent type of lung cancer is non-small-cell lung cancer (NSCLC) [ 1 – 3 ]. For the patients suffering from inoperable NSCLC, concurrent chemoradiotherapy (CCRT) is regarded as the standard first-line treatment (FLT) [ 4 – 6 ]. When performing the CCRT, traditional external radiotherapy is commonly used [ 4 – 6 ].…”

“…For the patients suffering from inoperable NSCLC, concurrent chemoradiotherapy (CCRT) is regarded as the standard first-line treatment (FLT) [ 4 – 6 ]. When performing the CCRT, traditional external radiotherapy is commonly used [ 4 – 6 ]. However, traditional external radiotherapy is typically associated with radiation- related complications, and the radiological dosing is limited by the distance between the tumor and the surrounding healthy tissue and vital organs [ 7 ].…”

A Canadian Perspective on the Challenges for Delivery of Curative-Intent Therapy in Stage III Unresectable Non-Small Cell Lung Cancer

“…The extensive staging work-up required to assess the feasibility for curative-intent treatment, and the need for consultation with a multidisciplinary team, further complicates the optimal, individualized management of stage III patients. In patients with unresectable disease who are fit (Eastern Cooperative Oncology Group Performance Status 0-1), have adequate lung function, and have a disease that can be encompassed within a radical radiation volume, chemoradiation therapy (CRT) using platinum-based chemotherapy is the standard of care [6]. Concurrent CRT (cCRT) is typically favoured for these patients, owing to multiple clinical studies showing its superiority to sequential CRT in stage III patients [7].…”