Chemotherapy Pluses Shown in Cancer Study : Medicine: Survival rate doubled in lung cancer patients, report says.
Chemotherapy undergone before radiation treatment doubled the survival rate of a group of patients with the most common type of inoperable lung cancer, according to a national study released today in the New England Journal of Medicine.
Of the patients who underwent only radiation therapy, 11% survived three years after treatment, contrasted with 23% who underwent five weeks of chemotherapy followed by six weeks of daily radiation therapy, according to the lead author of the study, Dr. Robert O. Dillman, medical director of the Hoag Cancer Center in Newport Beach.
“The good news is that just by adding that little bit of chemotherapy, there was a doubling in the survival rate,” Dillman said. “The bad news is that still didn’t help about 75% of the patients.”
Dr. John Glaspy, director of UCLA’s joint oncology clinic, said the study proves there are benefits to chemotherapy. But he noted that even the improved survival rates in the study were not good.
“The big point to the reader is, you’d better quit smoking--quick,” Glaspy said. “Because these big breakthroughs are changing survival rates by four months (on average), and that ain’t much.”
The three-year study began in 1984 and examined 155 patients with inoperable non-small-cell lung cancer, which affects as many as 40,000 Americans, Dillman said.
It was sponsored by the National Cancer Institute and conducted by a cooperative group of oncologists from Hoag, Massachusetts General Hospital in Boston, Dartmouth College in New Hampshire, UC San Diego Medical Center, McGill University in Montreal and the University of Missouri in Columbia.
Patients with this kind of inoperable cancer were given a five-week course of chemotherapy--two doses of the drug cisplatin and five doses of vinblastine. The duration was short enough so that patients were able to tolerate the side effects of the chemotherapy and still benefit from radiation treatment, Dillman said.
This was followed by six weeks of daily treatments of high-dose radiation therapy, concentrated on the chest area where the cancer was visible, Dillman said.
Major tumor shrinkage was seen in 44% of the patients who got both chemotherapy and radiation, contrasted with 35% in patients who received only radiation, the study said.
After one year of treatment, 55% of those who underwent chemotherapy and radiation therapy survived, contrasted with 40% among the radiation-only group. Three years after treatment, 23% of the chemotherapy-radiation group had survived, contrasted with 11% for the radiation-only group.
The three-year study was followed by three more years of tracking the patients and analyzing the data, Dillman said. At last count, three of the chemotherapy- radiation patients were still alive more than four years after treatment. Two were from Massachusetts General Hospital and one from McGill University.
A confirming study sponsored by the National Cancer Institute is under way across the country.
Dillman said the key finding is that chemotherapy, especially in earlier stages, is more effective in lung cancer than many doctors realize.
“Most patients with lung cancer are diagnosed by family practitioners or general internists, and they often have their initial care and treatment decisions made by those physicians,” Dillman said. “We know now that if we wait until (final stages of lung cancer) then chemotherapy is really too late. Patients will have severe side effects, won’t tolerate the therapy, and it won’t help.”
