Induction cisplatin/vinblastine and irradiation vs. irradiation in unresectable squamous cell lung cancer: Failure patterns by cell type in RTOG 88-08/ECOG 4588

Ritsuko Komaki, Charles B. Scott, William T. Sause, David H. Johnson, Samuel G. Taylor IV, Jin S. Lee, Bahman Emami, Roger W. Byhardt, Walter J. Curran, Abdul R. Dar, James D. Cox

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Abstract

Purpose: To analyze disease failure patterns by pretreatment characteristics and treatment groups in a prospective randomized trial. Methods and Materials: Patients with medically inoperable Stage II, unresectable IIIA and IIIB nonsmall cell lung cancer with KPS ≤70 and weight loss ≤5% were randomized to one of three treatment groups: standard radiation therapy with 60 Gy at 2.0 Gy per day (STD RT), induction chemotherapy with cisplatin 100 mg/m2 days 1 and 29 with vinblastine 5 mg/m2 weekly for 5 weeks followed by 60 Gy at 2.0 Gy per day (CT + RT), or hyperfractionated radiation therapy with 69.6 Gy at 1.2 Gy b.i.d. (HFX RT). Of 490 patients enrolled, 458 were evaluable. Minimum and median periods of observation for this analysis were 4 years and 6 years, respectively. Results: Pretreatment characteristics were equally distributed. Toxicities were previously reported. Median survival rates were 11.4, 13.6, and 12.3 months for STD RT, CT + RT, and HFX RT, respectively (log rank p = 0.05, Wilcoxon p = 0.04). Survivals were 20, 31, and 24% at 2 years, and 4, 11, and 9% at 4 years in the STD RT, CT + RT, and HFX RT groups, respectively. There were no differences in local tumor control rates among the treatments. Patterns of first failure showed less distant metastasis (DM) (other than brain) for CT + RT compared to the RT alone arms (p = 0.04). Within squamous cell carcinoma (SCC), DM (other than brain) rates were 43%, 16%, and 38% in SCC for STD RT, CT + RT, and HFX RT, respectively (p = 0.0015). Patients with peripheral/chest wall lesions were significantly more likely to fail first in the thorax when treated on STD RT compared to CT + RT and HFX RT (p = 0.009). Survival rates were similar among the treatment arms for patients with squamous cell carcinoma. Among patients with nonsquamous cell carcinoma, failure patterns did not differ by treatment group, but survival was significantly better in those who were treated by induction chemotherapy (p = 0.04). Conclusion: Patients with squamous cell carcinoma treated on the CT + RT arm had a significant reduction of first DM other than brain, but there was difference in survival. Survival favored CT + RT in nonsquamous carcinoma despite similar failure patterns. Reasons for improved survival with CT + RT in NSCLC are not yet available.

Original languageEnglish (US)
Pages (from-to)537-544
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume39
Issue number3
DOIs
StatePublished - Oct 1 1997

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Squamous Cell Neoplasms
Vinblastine
lungs
Cisplatin
Sexually Transmitted Diseases
Lung Neoplasms
induction
cancer
irradiation
Squamous Cell Carcinoma
cells
Survival
metastasis
Induction Chemotherapy
Arm
brain
Neoplasm Metastasis
chemotherapy
Brain
pretreatment

Keywords

  • Cisplatin/vinblastine plus irradiation
  • Irradiation alone
  • Unresectable squamous cell lung cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Induction cisplatin/vinblastine and irradiation vs. irradiation in unresectable squamous cell lung cancer : Failure patterns by cell type in RTOG 88-08/ECOG 4588. / Komaki, Ritsuko; Scott, Charles B.; Sause, William T.; Johnson, David H.; Taylor IV, Samuel G.; Lee, Jin S.; Emami, Bahman; Byhardt, Roger W.; Curran, Walter J.; Dar, Abdul R.; Cox, James D.

In: International Journal of Radiation Oncology Biology Physics, Vol. 39, No. 3, 01.10.1997, p. 537-544.

Research output: Contribution to journalArticle

Komaki, Ritsuko ; Scott, Charles B. ; Sause, William T. ; Johnson, David H. ; Taylor IV, Samuel G. ; Lee, Jin S. ; Emami, Bahman ; Byhardt, Roger W. ; Curran, Walter J. ; Dar, Abdul R. ; Cox, James D. / Induction cisplatin/vinblastine and irradiation vs. irradiation in unresectable squamous cell lung cancer : Failure patterns by cell type in RTOG 88-08/ECOG 4588. In: International Journal of Radiation Oncology Biology Physics. 1997 ; Vol. 39, No. 3. pp. 537-544.
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title = "Induction cisplatin/vinblastine and irradiation vs. irradiation in unresectable squamous cell lung cancer: Failure patterns by cell type in RTOG 88-08/ECOG 4588",
abstract = "Purpose: To analyze disease failure patterns by pretreatment characteristics and treatment groups in a prospective randomized trial. Methods and Materials: Patients with medically inoperable Stage II, unresectable IIIA and IIIB nonsmall cell lung cancer with KPS ≤70 and weight loss ≤5{\%} were randomized to one of three treatment groups: standard radiation therapy with 60 Gy at 2.0 Gy per day (STD RT), induction chemotherapy with cisplatin 100 mg/m2 days 1 and 29 with vinblastine 5 mg/m2 weekly for 5 weeks followed by 60 Gy at 2.0 Gy per day (CT + RT), or hyperfractionated radiation therapy with 69.6 Gy at 1.2 Gy b.i.d. (HFX RT). Of 490 patients enrolled, 458 were evaluable. Minimum and median periods of observation for this analysis were 4 years and 6 years, respectively. Results: Pretreatment characteristics were equally distributed. Toxicities were previously reported. Median survival rates were 11.4, 13.6, and 12.3 months for STD RT, CT + RT, and HFX RT, respectively (log rank p = 0.05, Wilcoxon p = 0.04). Survivals were 20, 31, and 24{\%} at 2 years, and 4, 11, and 9{\%} at 4 years in the STD RT, CT + RT, and HFX RT groups, respectively. There were no differences in local tumor control rates among the treatments. Patterns of first failure showed less distant metastasis (DM) (other than brain) for CT + RT compared to the RT alone arms (p = 0.04). Within squamous cell carcinoma (SCC), DM (other than brain) rates were 43{\%}, 16{\%}, and 38{\%} in SCC for STD RT, CT + RT, and HFX RT, respectively (p = 0.0015). Patients with peripheral/chest wall lesions were significantly more likely to fail first in the thorax when treated on STD RT compared to CT + RT and HFX RT (p = 0.009). Survival rates were similar among the treatment arms for patients with squamous cell carcinoma. Among patients with nonsquamous cell carcinoma, failure patterns did not differ by treatment group, but survival was significantly better in those who were treated by induction chemotherapy (p = 0.04). Conclusion: Patients with squamous cell carcinoma treated on the CT + RT arm had a significant reduction of first DM other than brain, but there was difference in survival. Survival favored CT + RT in nonsquamous carcinoma despite similar failure patterns. Reasons for improved survival with CT + RT in NSCLC are not yet available.",
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T1 - Induction cisplatin/vinblastine and irradiation vs. irradiation in unresectable squamous cell lung cancer

T2 - Failure patterns by cell type in RTOG 88-08/ECOG 4588

AU - Komaki, Ritsuko

AU - Scott, Charles B.

AU - Sause, William T.

AU - Johnson, David H.

AU - Taylor IV, Samuel G.

AU - Lee, Jin S.

AU - Emami, Bahman

AU - Byhardt, Roger W.

AU - Curran, Walter J.

AU - Dar, Abdul R.

AU - Cox, James D.

PY - 1997/10/1

Y1 - 1997/10/1

N2 - Purpose: To analyze disease failure patterns by pretreatment characteristics and treatment groups in a prospective randomized trial. Methods and Materials: Patients with medically inoperable Stage II, unresectable IIIA and IIIB nonsmall cell lung cancer with KPS ≤70 and weight loss ≤5% were randomized to one of three treatment groups: standard radiation therapy with 60 Gy at 2.0 Gy per day (STD RT), induction chemotherapy with cisplatin 100 mg/m2 days 1 and 29 with vinblastine 5 mg/m2 weekly for 5 weeks followed by 60 Gy at 2.0 Gy per day (CT + RT), or hyperfractionated radiation therapy with 69.6 Gy at 1.2 Gy b.i.d. (HFX RT). Of 490 patients enrolled, 458 were evaluable. Minimum and median periods of observation for this analysis were 4 years and 6 years, respectively. Results: Pretreatment characteristics were equally distributed. Toxicities were previously reported. Median survival rates were 11.4, 13.6, and 12.3 months for STD RT, CT + RT, and HFX RT, respectively (log rank p = 0.05, Wilcoxon p = 0.04). Survivals were 20, 31, and 24% at 2 years, and 4, 11, and 9% at 4 years in the STD RT, CT + RT, and HFX RT groups, respectively. There were no differences in local tumor control rates among the treatments. Patterns of first failure showed less distant metastasis (DM) (other than brain) for CT + RT compared to the RT alone arms (p = 0.04). Within squamous cell carcinoma (SCC), DM (other than brain) rates were 43%, 16%, and 38% in SCC for STD RT, CT + RT, and HFX RT, respectively (p = 0.0015). Patients with peripheral/chest wall lesions were significantly more likely to fail first in the thorax when treated on STD RT compared to CT + RT and HFX RT (p = 0.009). Survival rates were similar among the treatment arms for patients with squamous cell carcinoma. Among patients with nonsquamous cell carcinoma, failure patterns did not differ by treatment group, but survival was significantly better in those who were treated by induction chemotherapy (p = 0.04). Conclusion: Patients with squamous cell carcinoma treated on the CT + RT arm had a significant reduction of first DM other than brain, but there was difference in survival. Survival favored CT + RT in nonsquamous carcinoma despite similar failure patterns. Reasons for improved survival with CT + RT in NSCLC are not yet available.

AB - Purpose: To analyze disease failure patterns by pretreatment characteristics and treatment groups in a prospective randomized trial. Methods and Materials: Patients with medically inoperable Stage II, unresectable IIIA and IIIB nonsmall cell lung cancer with KPS ≤70 and weight loss ≤5% were randomized to one of three treatment groups: standard radiation therapy with 60 Gy at 2.0 Gy per day (STD RT), induction chemotherapy with cisplatin 100 mg/m2 days 1 and 29 with vinblastine 5 mg/m2 weekly for 5 weeks followed by 60 Gy at 2.0 Gy per day (CT + RT), or hyperfractionated radiation therapy with 69.6 Gy at 1.2 Gy b.i.d. (HFX RT). Of 490 patients enrolled, 458 were evaluable. Minimum and median periods of observation for this analysis were 4 years and 6 years, respectively. Results: Pretreatment characteristics were equally distributed. Toxicities were previously reported. Median survival rates were 11.4, 13.6, and 12.3 months for STD RT, CT + RT, and HFX RT, respectively (log rank p = 0.05, Wilcoxon p = 0.04). Survivals were 20, 31, and 24% at 2 years, and 4, 11, and 9% at 4 years in the STD RT, CT + RT, and HFX RT groups, respectively. There were no differences in local tumor control rates among the treatments. Patterns of first failure showed less distant metastasis (DM) (other than brain) for CT + RT compared to the RT alone arms (p = 0.04). Within squamous cell carcinoma (SCC), DM (other than brain) rates were 43%, 16%, and 38% in SCC for STD RT, CT + RT, and HFX RT, respectively (p = 0.0015). Patients with peripheral/chest wall lesions were significantly more likely to fail first in the thorax when treated on STD RT compared to CT + RT and HFX RT (p = 0.009). Survival rates were similar among the treatment arms for patients with squamous cell carcinoma. Among patients with nonsquamous cell carcinoma, failure patterns did not differ by treatment group, but survival was significantly better in those who were treated by induction chemotherapy (p = 0.04). Conclusion: Patients with squamous cell carcinoma treated on the CT + RT arm had a significant reduction of first DM other than brain, but there was difference in survival. Survival favored CT + RT in nonsquamous carcinoma despite similar failure patterns. Reasons for improved survival with CT + RT in NSCLC are not yet available.

KW - Cisplatin/vinblastine plus irradiation

KW - Irradiation alone

KW - Unresectable squamous cell lung cancer

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