Randomized phase I study of standard-fractionated or accelerated-hyperfractionated radiotherapy with concurrent cisplatin and vindesine for unresectable non-small cell lung cancer: a report of Japan Clinical Oncology Group Study (JCOG 9601)

History of Japan Clinical Oncology Group (JCOG) Lung Cancer Study Group

The Japan Clinical Oncology Group Lung Cancer Study Group has been carrying out clinical studies, exploring new strategies of treatment, supportive therapies (antiemetics, etc.), etc., for a variety of cancers, including not only small cell lung cancer and non-small cell lung cancer but also rare chest tumours (represented by thymoma) and cancer-associated conditions (cancerous pericarditis, cancerous pleuritis, etc.). In this review, an overview of all studies conducted from 1985 to 2019 is provided.

Non-conventional radiotherapy versus conventional radiotherapy for inoperable non-small-cell lung cancer: A meta-analysis of randomized clinical trials

BACKGROUND

  The aim of this study was to evaluate the efficacy and safety of non-conventional radiotherapy versus conventional radiotherapy for inoperable non-small-cell lung cancer and to conduct a meta-analysis to compare these two methods of radiotherapy for inoperable NSCLC.

METHODS

  We included randomized controlled trials, which were compared with non-conventional radiotherapy with or without concurrent chemotherapy versus conventional radiotherapy with or without concurrent chemotherapy.

RESULTS

  Meta-analysis of 13 randomized controlled trials with a total of 2206 patients showed that the non-conventional radiotherapy group could significantly improve the objective response rate (OR 1.68, 95% confidence intervals (CI) 1.19-2.37) and overall survival of up to 1-year (OR 1.30, 95% CI 1.09-1.54), 2-year (OR 1.41, 95% CI 1.17-1.70), 3-year (OR 1.55, 95% CI 1.24-1.94), 4-year (OR 1.60, 95% CI 1.20-2.15), 5-year (OR 1.63, 95% CI 1.11-2.38); and local control rate in 1-year (OR 1.35, 95% CI 1.09-1.68), 2-year (OR 1.57, 95% CI 1.23-1.99), 3-year (OR 1.45, 95% CI 1.10-1.91) compared with the conventional radiotherapy group. With regard to the side effects, non-conventional radiotherapy was more likely to result in level III and IV radioactive esophagitis (OR 1.64, 95% CI 1.09-2.46), but there was no significant difference in the incidence of radioactive pneumonitis (OR 0.96, 95% CI 0.67-1.39). In the subgroup analysis we found late course accelerated hyperfractionated radiotherapy (LCHRT) could obviously improve 1-year OS (OR 2.29, 95% CI 1.29-4.06), 2-year OS (OR 4.22, 95% CI 2.03-8.77), 3-year OS (OR 2.49, 95% CI 1.24-5.02) and Objective response rate (OR 2.38, 95% CI 1.17-4.83). However, hyperfractionated radiotherapy (HRT) and accelerated hyperfractionated radiotherapy (AHRT) could not improve 1-, 2-, 3-year OS or OR compared with conventional fractionation radiotherapy.

CONCLUSIONS

  Our findings indicate that NCRT could improve OR, reduce the risk of death by 1-5 years, and significantly increase level III and IV radioactive esophagitis incidence. The late course accelerated hyperfractionated radiotherapy (LCAHRT) group seemed to improve compared with the AHRT and conventional radiotherapy (CRT) groups.

Long-term follow-up of patients with unresectable locally advanced non-small cell lung cancer treated with chemoradiotherapy: a retrospective analysis of the data from the Japan Clinical Oncology Group trials (JCOG0003A)

To clarify the long-term survival data and factors that are correlated with survival outcome of unresectable locally advanced non-small cell lung cancer (NSCLC) following chemoradiotherapy, we analyzed patients who entered the Japan Clinical Oncology Group (JCOG) clinical trials for unresectable locally advanced NSCLC. Between October 1989 and August 1997, 240 patients (male 207, female 33; PS (performance status) 0 58, PS 1 172, PS 2 9, unknown 1; stage IIB 2, IIIA 62, IIIB 175, unknown 1) entered the 6 trials. All patients received chemotherapy and radiotherapy. The associations between survival outcome and treatment-related factors were analyzed using Cox regression analysis. Median survival times and 5-year survival rates in the trials were 11.9-19.7 months and 0-17.6%, respectively. Median survival time was 16.1 months and the 5- and 7-year survival rates of all 240 patients were 14.4% and 12.0%, respectively. No deaths were observed 7 years after initiation of the treatment or later. For stage IIIA and IIIB patients, the 5-year survival rates were 16.3% and 13.4%, respectively. Node status and age were significantly associated with survival, but no factors of the treatment were associated with survival of patients with unresectable locally advanced NSCLC. The present retrospective analysis showed that approximately 12% of patients with unresectable locally advanced NSCLC could be cured by various chemoradiotherapy regimens.