The Comparison of CAP Chemotherapy and Radiotherapy to Radiotherapy Alone for Resected Lung Cancer With Positive Margin or Involved Highest Sampled Paratracheal Node (Stage IIIA)

LCSG 791

¹ From the Medical Service, Veterans Affairs West Side Medical Center, Chicago

This study was conducted to determine the effect of adjuvant chemotherapy on locally advanced resected non-small cell lung cancer. Anatomic eligibility requirements were either positive resection margins or tumor involvement of the highest sampled mediastinal lymph node. One hundred seventy-two patients were randomized to receive either postoperative thoracic irradiation alone or together with six cycles of CAP chemotherapy (cyclophosphamide, doxorubicin, and cisplatin). The chemotherapy arm showed significantly longer recurrence-free survival (p=0.004). This benefit accrued to patients with both nonsquamous (p=0.01) and squamous (p=0.08) cell carcinoma. At 1 year following randomization, there was a 14% difference in survival favoring the chemotherapy arm. Chemotherapy significantly reduced distant metastases. Median survival was 20 months for the chemotherapy arm and 13 months for the radiotherapy alone arm. The 2-year survival rate for the entire study population was 35%. Toxic reactions were primarily predictable hematologic, GI, and alopecia toxicity expected from CAP. Esophagitis was not a significant problem.