Published: 2019-11-27

Comparative analysis of concurrent and sequential chemoradiation in locally advanced lung cancer: a single institution experience

Shelly Srivastava, Surendra Kumar Saini, S. K. Agarwal


Background: Outcome of various treatment regimen are dismal in non-small cell lung cancer. This analysis is done to find possible care in authors institutional set up and to see how these protocols have effect in Indian patients in term of toxicity.

Methods: Medical records and data on patients who had been diagnosed with non-small cell lung cancer histologically or cytologically, and who had been treated with sequential chemoradiation and concurrent chemoradiation at the hospital from January 2007 to March 2015 was retrospectively reviewed and analyzed. Two groups of sequential chemoradiotherapy and concurrent chemoradiotherapy were formed and compared for outcomes.

Results: Of the 114 evaluable patients in sequential chemoradiotherapy group, the median survival time was 16.0 months and the 1, 3- and 5-years overall survival were 57.0, 26.9 and 21.2%, respectively. Median progression free survival (PFS was 13.0 months and the 1, 3 and 5 years PFS were 52.6, 14.6 and 7.8%, respectively. In concurrent chemoradiotherapy group (105 patients), the overall median survival time was 15 months and the 1, 3- and 5-year overall survival were 56.2, 20.6 and 14.7%, respectively. Median PFS was 13 months and the 1, 3 and 5-year PFS were 48.8, 19.7 and 10.3%, respectively. Grade 3 and 4 toxicity in both regimen groups are same and statistically not significant.

Conclusions: Analysis confirm dismal outcome with standard treatment and signifies to search for care beyond conventional chemoradiotherapy.


Concurrent chemoradiotherapy, Lung cancer, Non-small cell lung cancer, Sequential chemoradiotherapy

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Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Lyon, France: International Agency for Research on Cancer; 2013. Cancer Incidence and Mortality Worldwide: IARC Cancer Base. 2012(11).

National Cancer Registry Programme. Three Year Report 2. of Population Based Cancer Registries: 2009-2011. Indian Council of Medical Research; 2013. Available at: accessed on January 21, 2014.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA: Cancer J Clini. 2005 Mar;55(2):74-108.

National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. New Eng J Med. 2011 Aug 4;365(5):395-409.

Komaki R, Scott CB, Byhardt R, Emami B, Asbell SO, Russell AH, et al. Failure patterns by prognostic group determined by recursive partitioning analysis (RPA) of 1547 patients on four radiation therapy oncology group (RTOG) studies in inoperable nonsmall-cell lung cancer (NSCLC). Int J Radi Oncol Biol Phys. 1998 Sep 1;42(2):263-7.

Vokes EE. Trends and perspectives in multimodality therapy of locoregionally advanced non-small cell lung cancer. Lung cancer. 2001 Oct 1;33:S85-9.

Hoffman PC, Mauer AM, Vokes EE. Lung cancer. Lancet. 2000;355:479-85.

Spira A, Ettinger DS. Multidisciplinary management of lung cancer. New Eng J Med. 2004 Jan 22;350(4):379-92.

Pfister DG, Johnson DH, Azzoli CG, Sause W, Smith TJ, Baker Jr S, et al. American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: Update 2003. J Clin Oncol. 2004 Jan 15;22(2):330-53.

Vokes EE, Herndon JE, Kelley MJ, Cicchetti MG, Ramnath N, Neill H, et al. Induction chemotherapy followed by chemoradiotherapy compared with chemoradiotherapy alone for regionally advanced unresectable stage III non–small-cell lung cancer: Cancer and Leukemia Group B. J Clin Oncol. 2007 May 1;25(13):1698-704.

Le Chevalier T, Arriagada R, Quoix E, Ruffle P, Martin M, Tarayre M, et al. Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: first analysis of a randomized trial in 353 patients. JNCI: J National Cancer Inst. 1991 Mar 20;83(6):417-23.

Dillman RO, Herndon J, Seagren SL, Eaton Jr WL, Green MR. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. JNCI: J National Cancer Inst. 1996 Sep 4;88(17):1210-5.

Clamon G, Herndon J, Cooper R, Chang AY, Rosenman J, Green MR. Radiosensitization with carboplatin for patients with unresectable stage III non–small-cell lung cancer: A phase III trial of the Cancer and Leukemia Group B and the Eastern Cooperative Oncology Group. J Clini Oncol. 1999 Jan;17(1):4.

Sause W, Kolesar P, Taylor IV S, Johnson D, Livingston R, Komaki R, et al. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest. 2000 Feb 1;117(2):358-64.

Gervais R, Ducolone A, Lechevalier T, Legroumellec A, Lemarie E, Quoix E. Conventional radiation with daily carboplatin compared with RT alone after induction chemotherapy: Final results of a randomized phase III trial in stage III unresectable non-small-cell lung cancer. Study CRT/BMS/NPC/96 of the French Lung Cancer Study Group FNCLCC and IFCT. J Clin Oncol. 2005;23:7016.

Furuse K, Fukuoka M, Kawahara M, Nishikawa H, Takada Y, Kudoh S, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small cell lung cancer. J Clin Oncol. 1999;17:2692-9.

Ulutin HC, Güden M, Oysul K, Sürenkök S, Pak Y. Split-course radiotherapy with or without concurrent or sequential chemotherapy in non-small cell lung cancer. Radi Medi. 2000;18(2):93-6.

Fournel P, Robinet G, Thomas P, Souquet PJ, Léna H, Vergnenégre A, et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non–small-cell lung cancer: Groupe Lyon-Saint-Etienne d’Oncologie Thoracique–Groupe Francais de Pneumo-Cancérologie NPC 95-01 Study. J Clin Oncol. 2005;23:5910-7.

Zatloukal P, Petruzelka L, Zemanova M, Havel L, Janku F, Judas L, et al. Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung cancer. 2004 Oct 1;46(1):87-98.

Belderbos J, Uitterhoeve L, van Zandwijk N, Belderbos H, Rodrigus P, van de Vaart P, et al. Randomised trial of sequential versus concurrent chemo-radiotherapy in patients with inoperable non-small cell lung cancer (EORTC 08972-22973). Eur J cancer. 2007 Jan 1;43(1):114-21.

Bradley J, Graham MV, Winter K, Purdy JA, Komaki R, Roa WH, et al. Toxicity and outcome results of RTOG 9311: A phase I-II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radi Oncol Biol Physics. 2005 Feb 1;61(2):318-28.