Lung cancer is the greatest in quan...

Lung cancer is the greatest in quantity common cause of cancer mortality worldwide. Surgical resection is attempted for non-small-cell lung cancer when feasible, further the role of adjuvant chemotherapy has been unclear. Several randomized trials of chemotherapy have failed to point out to any benefit, but a fresh meta-analysis of cisplatin-based chemotherapy glance ated that a survival advantage was possible. The International Adjuvant Lung Cancer Trial (IALT) Collaborative arrange designed a randomized trial of postsurgical chemotherapy, including cisplatin for patients with non-small-cell lung cancer, to determine if a survival benefit could be demonstrated.

To maximize enrollment and increase the statistical power of the trial to identify a survival advantage as small as 5 percent five years after treatment, the IALT protocol had scarcely any restrictions. Each participating center could decide which stages of lung cancer to include (up to stage III), which chemotherapeutic agent to include with cisplatin, and whether to furnish postoperative radiotherapy in addition to chemotherapy. A total number of 1867 patients was randomized; this number was short of the 3300 target enrollment chiefly because of declining enrollment later in the reflection when preoperative chemotherapy became more commonly employed

Participants were randomized to receive chemotherapy within 60 days of surgery or observation alone. The median follow-up period was 56 month and 98 percent of patients had without fault [i]or[/i] blemish [i]or[/i] flaw data available for survival analysis. The target dosage for cisplatin (at least 240 mg by m2 of body surface area) could not be reached in 262 percent of patients. The greatest in quantity common reason this dosage could not be reached was adverse validitys related to chemotherapy. Com plete refusal of chemotherapy occurr in 78 percent of cases. Etoposide was the chemotherapeutic agent in the greatest degree often selected to accompany cisplatin. Postoperative radiotherapy was planned in 306 percent of trial make subordinates and was evenly distributed among the chemotherapy and observation clusters via randomization.

The overall survival rate at five years was calculated to be 445 percent in those receiving adjuvant chemotherapy, compared with 404 percent in the dispose assigned to observation. Disease-free survival at the five-year mark was 394 percent in the cluster treated with chemotherapy and 343 percent in the observation dispose Chemotherapy was lethal in 08 percent of cases and caused at least single potentially life-threatening complication (mostly neutropenia) in 226 percent of patients.

The authors terminate that postsurgical chemotherapy that includes cisplatin increases the five-year survival rate in patients with non-small-cell lung cancer.

BILL ZEPF MD International Adjuvant Lung Cancer Trial Collaborative form into groups Cisplatin-based adjuvant chemotherapy in patients with completely resect non-small-cell lung cancer. N Engl J M January 22 2004;350:351-60

EDITOR'S NOTE: An accompanying editorial (1) describes postsurgical cisplatin as the "new standard of care" in the treatment of non-small-cell lung cancer. It is far from clear, however, whether many patients or physicians will agree that the statistical significance seen in the IALT contemplation corresponds to clinical relevance. The small increase in survival after five years (41 percent) must be balanced with the 1 percent chance of death related to chemotherapy, the one-in-four chance of a life-threatening complication during treatment, and the substantial investment of time and courage lacked to endure three or four round of yearss of chemotherapy. Observation alone still may be seen by way of many as a prudent option, considering the overall odds

REFERENCE

(1) Blum RH Adjuvant chemotherapy for lung cancer--a recent standard of care [Editorial]. N Engl J M January 22 2004;350:404-5

COPYRIGHT 2004 American Academy of Family Physicians

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