Multivariate Analysis of Survival, Local Control, and Time to Distant Metastases in Patients with Unresectable Non-Small-Cell Lung Carcinoma Treated with 3-Dimensional Conformal Radiation Therapy with or Without Concurrent Chemotherapy

BACKGROUND: Three-dimensional (3D) conformal radiation therapy (CRT) and chemotherapy have recently improved lung cancer management. PATIENTS AND METHODS: We reviewed outcomes in 68 patients with unresectable stage I-III non-small-cell lung cancer. Treatment consisted of 3D CRT alone or with concurrent chemotherapy (CCR). RESULTS: Concurrent chemotherapy improved survival, to a median of 17 months ± 4.9 months, compared with 8 months ± 4.1 months for the radiation therapy (RT) alone group (P = 0.0347). The 2- and 5-year survival rates were 40.3% ± 7.7% and 14.1% ± 6.4%, repectively, with CCR, compared with 19.6% ± 9.6% and 0, respectively, for RT alone. In a subgroup analysis for age > 65, patients who received CCR (n = 20) had significantly improved survival and local control (P = 0.005 and P = 0.0286, respectively). Acute esophageal toxicity Radiation Therapy Oncology Group grade ≤ 3 was significantly higher in the CCR group and correlated with the RT dose (19% in CCR vs. 0 in RT, P = 0.0234; P = 0.050). The overall incidences of esophageal and pulmonary toxicity grade ≤ 3 were 20.6% and 5.9%, respectively. CONCLUSION: Our study confirms that CCR is associated with improved survival over RT alone, with a tolerable increase in acute toxicity.