“A comparative study using conventional concomitant chemoradiotherapy (using cisplatin-based chemotherapy) with accelerated (six fractions a week) chemoradiotherapy in inoperable or nonresectable locally advanced non-small cell lung cancers:” A prospective randomized trial

Context: The conventional concomitant chemoradiotherapy (CCRT) is the standard treatment for locally advanced non-small cell lung cancer. Accelerated CCRT results in shortening of overall treatment time which can contribute in controlling accelerated tumor repopulation. The increase in tumor control probability (TCP) can be expected with no or little effect on late normal tissue injury for a given total dose. Aim: The aim of this study was to compare the disease response, toxicity profile, quality of life (QoL), and overall survival in accelerated versus conventional CCRT. Subjects and Methods: Total 42 patients were randomized into two groups – study group (n = 21): Accelerated CCRT, radiation was given as 6 fractions per week (60 Gy/5 weeks/30#) with injection cisplatin 20 mg/m² intravenous (iv) days 1–5 and days 29–33 + injection etoposide 50 mg/m² iv days 1–5 and days 29–33 and control group (n = 21): Conventional CCRT, radiation was given as 5 fractions per week (60 Gy/6 weeks/30#) along with the same chemotherapy. External beam radiation therapy was delivered by cobalt-60 machines. Results: The overall response rate (complete and partial response) for all patients was 66.6%. In the control group, it was 66.2%, and in the study group, it was 66.6%. Grade ≥II pulmonary, hematological, and esophageal toxicities were seen in 57%, 43%, and 24% in patients of the control group and 53%, 53%, and 33% in the study group, respectively. In QoL analysis, maximum improvement was noted for hemoptysis, arm/shoulder pain, dyspnea, and chest pain in both the groups. Statistical Analysis Used: The data were analyzed by Student's t-test and Chi-square test. P < 0.05 was taken as statistically significant. Conclusion: As response rates and disease progression were similar in both the groups, accelerated chemoradiotherapy can be considered as an alternate therapy, especially in high-volume centers.