A Comparative Study on Response of Concurrent versus Sequential Chemoradiation in Inoperable Locally Advanced Non-Small Cell Lung Cancer

Abstract

INTRODUCTION: Nearly one third of non-small cell lung cancer (NSCLC) patients present in locally advanced stage (stage III). Various clinical trials have proved that the combination of chemotherapy and radiotherapy produce better response in inoperable locally advanced NSCLC. But the optimal sequencing and integrating scheme is yet to be established. OBJECTIVE : To evaluate and compare the response of concurrent (simultaneous chemotherapy and radiotherapy) and sequential (chemotherapy followed by radiotherapy) chemoradiation approach using the same chemotherapeutic agents and radiation dose in locally advanced NSCLC patients. METHODS AND MATERIAL: A Quasi-experimental study was carried out in the Department of Radiotherapy of Rajshahi Medical College Hospital. Sixty six diagnosed patients were enrolled on the basis of eligibility criteria and allocated into two groups by purposive sampling. The concurrent arm was treated with thoracic radiotherapy (60 Gy in 30 fraction) by conventional planning with concomitant Inj. Cisplatin and Inj. Etoposide on day 1-5 and day 29-33 of radiotherapy and the sequential arm was treated with Inj. Cisplatin and Inj. Etoposide on day 1-3, I/V 4 weekly for 3 cycles, if no progression occurred it was followed by radiotherapy with same radiation dose and technique. RESULTS: In this study the overall response was higher in concurrent arm than sequential arm (78.8% vs 72.7%) but the superiority was not confirmed statistically (p=0.56). CONCLUSION: Concurrent chemoradiation had slightly higher response, but considering its toxicity profile, it should be the choice of treatment approach in patients with good performance status. KEYWORD: Non-small cell lung cancer, Chemoradiotherapy