Table 1. Randomized studies evaluating concurrent chemotherapy in combination with thoracic EBRT for patients with incurable NSCLC

First Author (Institution) / Number of Patients / Eligibility / Intervention / Median Survival
Ball, 19971
(Peter MacCallum Cancer Institute/Royal Adelaide Hospital) / 200 / Incurable NSCLC, eligibility not otherwise specified / 1. RT: 20 Gy in 5 fractions
2. ChemoRT: same RT with 1 cycle of concurrent continuous infusion of 5-fluorouracil (1 mg/m2/day) for 5 days / RT: 6.0 months
ChemoRT: 6.8 months
(P=0.36)
Nawrocki, 20102
(University of Warmia and Mazury/Maria Sklodowska-Curie Oncology Centre) / 99 / Incurable stage III NSCLC, defined as FEV1 ≤ 40% predicted or GTV > 8 cm in maximum diameter
ECOG PS 0-2 / 1. RT: 30 Gy in 10 fractions
2. ChemoRT: same RT with 3 cycles of chemo (cisplatin 80 mg/m2 on day 1, vinorelbine 25 mg/m2 on days 1 and 8); RT given concurrently with cycle 3 / RT: 9.0 months
ChemoRT: 12.9 months
(P=0.034)
Strom, 20133
(Multi-institutional) / 191 / Incurable stage III NSCLC, defined as GTV ≥ 8 cm in maximum diameter, ECOG PS ≥ 2*, or 10% weight loss in 6 months / 1. Chemo: carboplatin AUC = 5 on day 1, vinorelbine 60 mg/m2 on days 1 and 8
2. ChemoRT: same chemo with RT (42 Gy in 15 fractions); RT given concurrently with cycle 2 / Chemo: 9.7 months
ChemoRT: 12.6 months
(P<0.01)

EBRT= external beam radiation therapy; ECOG = Eastern Cooperative Oncology Group; NSCLC = non-small cell lung cancer; chemo = chemotherapy; ChemoRT = chemoradiation; RT = radiation therapy; FEV1 = forced expiratory volume in first second; GTV = gross tumor volume; PS = performance status

* 79% of patients enrolled had ECOG PS of 0 or 1, 21% had ECOG PS of 2

Table 2. Toxicity and quality of life reported in randomized studies evaluating concurrent chemotherapy in combination with thoracic EBRT for patients with incurable NSCLC

First Author (Institution) / Intervention / Acute Toxicity / Quality of Life
Ball, 19971
(Peter MacCallum Cancer Institute/Royal Adelaide Hospital) / 1. RT: 20 Gy in 5 fractions
2. ChemoRT: same RT with 1 cycle of concurrent continuous infusion of 5-fluorouracil (1 mg/m2/day) for 5 days / Grade 3 esophagitis:
RT: 3%
ChemoRT: 12%
(P < 0.01) / Chest-related symptoms and overall QOL post-treatment not significantly different between arms
Nawrocki, 20102
(University of Warmia and Mazury/Maria Sklodowska-Curie Oncology Centre) / 1. RT: 30 Gy in 10 fractions
2. ChemoRT: same RT with 3 cycles of chemo (cisplatin 80 mg/m2 on day 1, vinorelbine 25 mg/m2 on days 1 and 8); RT given concurrently with cycle 3 / Grade 3-4 esophagitis:
RT: 0%
ChemoRT: 2%
(Not significant) / Chest-related symptoms improved post-treatment in both arms, but degree of improvement between arms not tested for significance
Strom, 20133
(Multi-institutional) / 1. Chemo: carboplatin AUC = 5 on day 1, vinorelbine 60 mg/m2 on days 1 and 8
2. ChemoRT: same chemo with RT (42 Gy in 15 fractions); RT given concurrently with cycle 2 / Grade 3 esophagitis:
Chemo: 1.5%
ChemoRT: 30%
(P < 0.01) / Global HRQOL worse for chemo only arm beyond 3 months post-treatment

EBRT= external beam radiation therapy; NSCLC = non-small cell lung cancer; chemo = chemotherapy; ChemoRT = chemoradiation; RT = radiation therapy

1.Ball D, Smith J, Bishop J, et al. A phase III study of radiotherapy with and without continuous-infusion fluorouracil as palliation for non-small-cell lung cancer. Br J Cancer. 1997;75(5):690-697.

2.Nawrocki S, Krzakowski M, Wasilewska-Tesluk E, et al. Concurrent chemotherapy and short course radiotherapy in patients with stage IIIA to IIIB non-small cell lung cancer not eligible for radical treatment: results of a randomized phase II study. J Thorac Oncol. 2010;5(8):1255-1262.

3.Strom HH, Bremnes RM, Sundstrom SH, Helbekkmo N, Flotten O, Aasebo U. 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. Br J Cancer. 2013;109(6):1467-1475.