BMC Cancer (Apr 2020)

Efficacy and safety of concurrent chemoradiotherapy in ECOG 2 patients with locally advanced non-small-cell lung cancer: a subgroup analysis of a randomized phase III trial

  • Nan Bi,
  • Lipin Liu,
  • Jun Liang,
  • Shixiu Wu,
  • Ming Chen,
  • Changxing Lv,
  • Lujun Zhao,
  • Anhui Shi,
  • Wei Jiang,
  • Yaping Xu,
  • Zongmei Zhou,
  • Jingbo Wang,
  • Wenqing Wang,
  • Dongfu Chen,
  • Zhouguang Hui,
  • Jima Lv,
  • Hongxing Zhang,
  • Qinfu Feng,
  • Zefen Xiao,
  • Xin Wang,
  • Tao Zhang,
  • Weibo Yin,
  • Junling Li,
  • Jie He,
  • Luhua Wang

DOI
https://doi.org/10.1186/s12885-020-06780-x
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 10

Abstract

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Abstract Background There is no consensus on the therapeutic approach to ECOG 2 patients with locally advanced non-small-cell lung cancer (LA-NSCLC), despite the sizable percentage of these patients in clinical practice. This study focused on the efficacy, toxicity and the optimal chemotherapy regimen of CCRT in ECOG 2 patients in a phase III trial. Methods Patients capable of all self-care with bed rest for less than 50% of daytime were classified as ECOG 2 subgroup. A subgroup analysis was performed for ECOG 2 patients recruited in the phase III trial receiving concurrent EP (etoposide + cisplatin)/PC (paclitaxel + carboplatin) chemotherapy with intensity-modulated radiation therapy (IMRT) or three-dimensional conformal external beam radiation therapy (3D-CRT). Results A total of 71 ECOG 2 patients were enrolled into the study. Forty-six (64.8%) patients were treated with IMRT technique. The median overall survival (OS) and progression free survival (PFS) for ECOG 2 patients were 16.4 months and 9 months, respectively. No difference was observed in treatment compliance and toxicities between ECOG 2 patients and ECOG 0–1 patients. Within the ECOG 2 group (31 in the EP arm and 40 in the PC arm), median OS and 3-year OS were 15.7 months and 37.5% for the EP arm, and 16.8 months and 7.5% for the PC arm, respectively (p = 0.243). The incidence of grade ≥ 3 radiation pneumonitis was higher in the PC arm (17.5% vs. 0.0%, p = 0.014) with 5 radiation pneumonitis related deaths, while the incidence of grade 3 esophagitis was numerically higher in the EP arm (25.8% vs. 10.0%, p = 0.078). Conclusions CCRT provided ECOG 2 patients promising outcome with acceptable toxicities. EP might be superior to PC in terms of safety profile in the setting of CCRT for ECOG 2 patients. Prospective randomized studies based on IMRT technique are warranted to validate our findings. Trial registration ClinicalTrials.gov registration number: NCT01494558 . (Registered 19 December 2011).

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