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Radiation plus Chemotherapy

In patients strong enough to tolerate both, there have been many studies that show that survival results are better if radiation is combined with radiation (see survival curve from the meta-analysis.)

 Several recent trials are noted here, and with high dose radiation combined with chemotherapy the median survival is now 2 -3 years.
lung_advanced_cancer_adam.jpg (7702 bytes) see the studies and data

Some of the more recent RTOG lung protocols are noted (Lee and Byhardt and the RTOG 94-10) below. The study below by Choy also showed good results with taxol, carboplatinum  plus radiation.

In summary radiation alone (often in the sickest patents) results in median survival of 6 - 9 months and some of the more aggressive chemotherapy plus radiation regimens (especially concurrent Taxol/radiation) have median survival rates of 20 months.

Induction chemoRx clearly provides a benefit (CALGB 8433 survival went from 7%/5y to 19% over radiation alone.) But concurrent chemoRd is probably better than sequential (RTOG 9410 with no additional benefit from bid XRT.

RTOG 94-10 Trial
  Sequential Concurrent Hyperfractionation
Response Rate 59% 68% 63%
Survival 14.6 months 17.1 months 15.6 months

Velban (5mg/M2/w) + Cisplatin (100mg/M2, d1, d29) + XRT (63Gy or HF was 69.6Gy)            

Rosenman reported from UNC the LCCC9603 trial using induction Carbo/Taxol then concurrent chemoradiation with higher XRT doses of 74Gy and noted a median survival of 24 months and 29% at 5 years / and noted other high dose chemoradiation trials are reporting median survival of 15.6 to 19 months.