Chapter 085. Neoplasms of the Lung (Part 13)

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Table 85-5 Randomized Studies of Adjuvant Chemotherapy in NSCLC Stu dy Treatment mber Nu of Year 5edian M zard Ha Value p Patients Survival Survival Ratio (%) (95% CI) EC OG Surgery 242 9% 246 3 39 months vs. 0.9 3 (0.74– .56 0 3590 →RT vs. Surgery + post-op concurrent (II–IIIA) 38 1.18) 3 RT + cis/etoposide 3% months AL Surgery 603 1% 606 5 R N 6 0.9 (0.8– .59 0 PI (I–IIIA) alone vs. Surgery + post-op mitomycin/vindesin e/cisplatin 3% 4 1.1) Big Surgery 189 33 months 1.0 2 (0.77– .90 1.35) 0 Lung Trial alone vs. Surgery + 192 (I–IIIB) post-op 34 chemotherapy a months IAL Surgery 405 0% 361 4 R N 0.8 6 (0.76– 0.03 0.98) ...

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Nội dung Text: Chapter 085. Neoplasms of the Lung (Part 13)

Chapter 085. Neoplasms of the Lung (Part 13) Table 85-5 Randomized Studies of Adjuvant Chemotherapy in NSCLC Stu Treatment Nu 5- M Ha p dy mber of Year edian zard Value Patients Survival Survival Ratio (%) (95% CI) EC Surgery 242 3 39 0.9 0 OG 3590 →RT vs. Surgery + 9% months 3 (0.74– .56 246 (II–IIIA) post-op concurrent vs. 38 1.18) 3 RT + cis/etoposide months 3% AL Surgery 603 5 N 0.9 0 PI (I–IIIA) alone vs. Surgery + 1% R 6 (0.8– .59 606 post-op
mitomycin/vindesin 4 1.1) e/cisplatin 3% Big Surgery 189 33 1.0 0 Lung Trial alone vs. Surgery + months 2 (0.77– .90 192 (I–IIIB) post-op 1.35) 34 a chemotherapy months IAL Surgery 405 4 N 0.8 < TIB–IIIA alone vs. Surgery + 0% R 6 (0.76– 0.03 361 post-op Cis + 0.98) 4 VP16/vinca 4.5% UF Surgery 488 8 — 0.7 0 TIA–IB alone vs. Surgery + 5% 1 (0.52– .04 469 post-op UFT 0.98) 8 8% CA Surgery 172 5 78 0.8 0 LGB IB alone vs. Surgery + 0 (0.60–
(ASCO post-op 172 7% months 1.07) .10 06) carbo/paclitaxel 5 95 9% months NC Surgery 241 5 73 0.6 0 I-CIB–II alone vs. Surgery + 4% months 9 (0.52– .04 241 post-op 0.91) 6 94 Cis/vinorelbine 9% months AN Surgery 433 4 44 0.7 0 ITA IB, II, alone vs. Surgery + 3% months 9 (50– .017 407 IIIA post-op 88.5) 5 66 Cis/vinorelbine 1% months a Chemotherapy allowed: mitomycin, cisplatin, ifosfamide; mitomycin, vinblastine, cisplatin; cisplatin, vindesine; cisplatin, vinorelbine. Note: RT, radiation therapy; NR, not reported; UFT, tegafur and uracil. The role of adjuvant chemotherapy for stage IB disease is undefined. Subset analysis of all the randomized studies showed no benefit in patients with
stage IB. In addition, one clinical trial focusing solely on IB disease and using carboplatin and paclitaxel (one of the most commonly used regimens for advanced disease) found a hazard ratio of 0.80 (20% reduction in death with adjuvant chemotherapy) that was not statistically significant. Thus, patients with stage IB NSCLC are not routinely given adjuvant therapy. Adjuvant Radiotherapy for NSCLC Stages I–II After apparent complete resection, postoperative adjuvant radiation therapy does not improve survival and may actually be detrimental to survival in N0 and N1 disease.