Chemotherapy Plus Radiation Therapy With or Without Surgery in Treating Patients With Stage IIIA Non-small Cell Lung Cancer
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ClinicalTrials.gov Identifier: NCT00002550 |
Recruitment Status :
Completed
First Posted : April 10, 2003
Last Update Posted : November 17, 2015
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RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining radiation therapy with chemotherapy may kill more tumor cells. It is not yet known if chemotherapy plus radiation therapy is more effective with or without surgery for lung cancer.
PURPOSE: Randomized phase III trial to compare the effectiveness of combining cisplatin, etoposide, and radiation therapy with or without surgery in treating patients who have stage IIIA non-small cell lung cancer.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Lung Cancer | Drug: cisplatin Drug: etoposide Procedure: conventional surgery Radiation: radiation therapy | Phase 3 |
OBJECTIVES:
Primary
- Compare the progression-free survival, median (2-year) survival, and long-term (5-year) survival in patients with newly diagnosed, stage IIIA (N2) non-small cell lung cancer treated with radiotherapy concurrently with cisplatin and etoposide with or without surgical resection.
Secondary
- Compare the patterns of local and distant failure in patients treated with these regimens.
- Determine the relationship of tobacco use, alcohol use, and diet with toxicity of these regimens and outcome in both men and women.
OUTLINE: This is a randomized, multicenter study. Patients are stratified by contralateral mediastinal sampling or biopsy (yes vs no), tumor stage (T1 vs T2 vs T3), and performance status (70-80% vs 90-100%). Patients are randomized to 1 of 2 treatment arms.
- Arm I: Patients receive induction with cisplatin IV over 1 hour on days 1 and 8 and etoposide IV over 1 hour on days 1-5. Treatment continues every 4 weeks for 2 courses in the absence of disease progression or unacceptable toxicity. Beginning within 24 hours of the first dose of chemotherapy, patients undergo induction radiotherapy 5 days a week for 5 weeks in the absence of disease progression or unacceptable toxicity. Patients without local progression or distant metastases at 2-4 weeks after completion of course 2 undergo resection approximately 3-5 weeks after completion of course 2. All visible, accessible bronchopulmonary, hilar, and mediastinal lymph nodes are excised. The choice of surgical procedure (thoracotomy, lobectomy, or pneumonectomy with en bloc resection of tumor extending into the parietal pleura, chest wall, pericardium, or diaphragm) is at the discretion of the surgeon. Patients who undergo resection receive 2 additional courses of chemotherapy alone beginning 4-6 weeks postoperatively. Patients with unresectable disease or who are medically unfit for or refuse resection receive 2 additional courses of chemotherapy alone beginning immediately after completion of course 2.
- Arm II: Patients undergo induction chemoradiotherapy as in arm I but do not undergo resection. Patients without local progression or distant metastases within 1 week before anticipated completion of induction radiotherapy receive 2 additional courses of chemotherapy beginning immediately after completion of course 2. Patients without local or distant progression after completion of course 4 undergo boost radiotherapy for 8 days.
Patients are followed every 2 months for 1 year, every 3 months for 2 years, and then every 6 months thereafter.
PROJECTED ACCRUAL: A total of 510 patients will be accrued for this study within 4.9 years.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 429 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Phase III Comparison Between Concurrent Chemotherapy Plus Radiotherapy and Concurrent Chemotherapy Plus Radiotherapy Followed by Surgical Resection for Stage IIIA (N2) Non-Small Cell Lung Cancer |
Study Start Date : | March 1994 |
Actual Primary Completion Date : | June 2004 |
Actual Study Completion Date : | November 2013 |
Arm | Intervention/treatment |
---|---|
Experimental: RT + chemotherapy followed by surgery + chemotherapy
Induction radiation therapy (RT) + concurrent induction chemotherapy followed by surgery and additional chemotherapy
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Drug: cisplatin Drug: etoposide Procedure: conventional surgery Radiation: radiation therapy |
Active Comparator: RT + chemotherapy followed by chemotherapy + RT
Induction RT + concurrent induction chemotherapy followed by additional chemotherapy + RT
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Drug: cisplatin Drug: etoposide Radiation: radiation therapy |
- Median overall survival [ Time Frame: From randomization to date of death or last follow-up. Analysis occurs after patients have been potentially followed for 2.5 years. ]
- Median Progression-free survival [ Time Frame: From randomization to date of death or last follow-up. Analysis occurs after patients have been potentially followed for 2.5 years. ]
- Patterns of local and distant failure [ Time Frame: From randomization to date of failure (local, regional or distant progression). Analysis occurs after patients have been potentially followed for 2.5 years. ]
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
-
Histologically or cytologically proven newly diagnosed, stage IIIA (T1-3, N2) non-small cell lung cancer
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Eligible subtypes:
- Adenocarcinoma
- Large cell carcinoma
- Squamous cell carcinoma
- Nonlobar and nondiffuse bronchoalveolar cell carcinoma
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-
Measurable or evaluable disease on chest x-ray and/or contrast CT scan
- Contrast thoracic CT required to complete staging
- Single primary bronchogenic tumor (no more than 1 parenchymal lung lesion)
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Pleural effusions allowed if 1 of the following conditions is met:
- Negative cytology on thoracentesis if effusions present before mediastinoscopy or exploratory thoracotomy
- Effusion seen on CT scan but not on chest x-ray and deemed too small to tap under CT or ultrasound guidance
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Positive ipsilateral mediastinal node(s) with or without positive ipsilateral hilar nodes
- Mediastinal nodes separate from primary lesion on CT scan or surgical exploration
- Histologic or cytologic proof of N2 disease by thoracotomy, mediastinoscopy, mediastinotomy, Chamberlain procedure, Wang needle, or fine needle aspiration under bronchoscopic or CT guidance
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Nodal biopsy or aspiration waived if all of the following conditions are met:
- Paralyzed left true vocal cord documented by bronchoscopy or indirect laryngoscopy
- Nodes visible in Level 5 region on CT scan
- Distinct primary lesion separate from nodes on CT scan
- All mediastinal nodal involvement mapped (positive or negative)
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No positive nodes in contralateral mediastinum (supraclavicular areas and higher) and neck
- Mediastinoscopy, mediastinotomy, Chamberlain procedure, or thoracotomy required for nodes larger than 1 cm on contrast CT scan
- Surgery waived if nodes negative or no larger than 1 cm on CT scan
- Lymphadenopathy allowed if biopsy proof of a benign cause
- No metastases by contrast CT or MRI scan of the brain, bone scan, CT scan of the lungs to exclude other ipsilateral or contralateral parenchymal lesions, and contrast CT scan of the upper abdomen including entire liver and adrenals
- No hepatomegaly or splenomegaly by physical examination or CT scan unless documentation of a benign cause
- No pericardial effusion
- No superior vena cava syndrome
- No prior diagnosis of lung cancer
PATIENT CHARACTERISTICS:
Age:
- 18 and over
Performance status:
- Karnofsky 90-100% (70-80% allowed if albumin at least 0.85 times lower limit of normal and weight loss no greater than 10% within 3 months before diagnosis)
Hematopoietic:
- White blood cell count (WBC) at least 4,000/mm^3 OR
- Granulocyte count at least 2,000/mm^3
- Platelet count normal
- Hemoglobin at least 10.0 g/dL (less than 8.5 g/dL allowed if no marrow involvement with tumor)
Hepatic:
- See Performance status
- Bilirubin no greater than 1.5 times upper limit of normal (ULN)*
- Serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) no greater than 1.5 times ULN* NOTE: * Unless documentation of a benign cause
Renal:
- Creatinine clearance at least 50 mL/min
Cardiovascular:
- No myocardial infarction within the past 3 months
- No active angina
- No unstable arrhythmia
- No congestive heart failure
Pulmonary:
- Forced expiratory volume at one second (FEV1) at least 2.0 liters OR
- Predicted postresection FEV1 at least 800 mL based on quantitative V/Q scan
- Diffusion capacity of lung for carbon monoxide (DLCO) at least 50% predicted (corrected for hemoglobin) if pneumonectomy planned or likely after induction chemotherapy
Other:
- No clinically significant hearing loss unless willing to accept the potential of further loss
- No symptomatic peripheral neuropathy
- No peptic ulcer disease under active treatment
- No other medical illness not controllable by appropriate medical therapy
- No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or ductal or lobular carcinoma in situ of the breast
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- No concurrent colony-stimulating factors
Chemotherapy:
- No prior chemotherapy for lung cancer
- No concurrent chemotherapy for another condition (such as arthritis)
Endocrine therapy:
- Not specified
Radiotherapy:
- No prior radiotherapy for lung cancer
Surgery:
- See Disease Characteristics
- No prior resection of primary tumor
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00002550
United States, Illinois | |
CCOP - Carle Cancer Center | |
Urbana, Illinois, United States, 61801 | |
United States, Indiana | |
Indiana University Cancer Center | |
Indianapolis, Indiana, United States, 46202-5289 | |
Veterans Affairs Medical Center - Indianapolis (Roudebush) | |
Indianapolis, Indiana, United States, 46202 | |
United States, Iowa | |
CCOP - Cedar Rapids Oncology Project | |
Cedar Rapids, Iowa, United States, 52403-1206 | |
United States, Michigan | |
CCOP - Ann Arbor Regional | |
Ann Arbor, Michigan, United States, 48106 | |
United States, Nebraska | |
CCOP - Missouri Valley Cancer Consortium | |
Omaha, Nebraska, United States, 68106 | |
United States, New York | |
University of Rochester Cancer Center | |
Rochester, New York, United States, 14642 | |
United States, Ohio | |
Ireland Cancer Center | |
Cleveland, Ohio, United States, 44106-5065 | |
CCOP - Toledo Community Hospital Oncology Program | |
Toledo, Ohio, United States, 43623-3456 | |
United States, Pennsylvania | |
Hahnemann University Hospital | |
Philadelphia, Pennsylvania, United States, 19102-1192 | |
University of Pittsburgh Cancer Institute | |
Pittsburgh, Pennsylvania, United States, 15213-3489 | |
United States, Tennessee | |
Vanderbilt-Ingram Cancer Center | |
Nashville, Tennessee, United States, 37232-6838 | |
United States, Wisconsin | |
CCOP - Green Bay | |
Green Bay, Wisconsin, United States, 54301 | |
Medical College of Wisconsin | |
Milwaukee, Wisconsin, United States, 53226 | |
Veterans Affairs Medical Center - Milwaukee (Zablocki) | |
Milwaukee, Wisconsin, United States, 53295 | |
South Africa | |
Pretoria Academic Hospitals | |
Pretoria, South Africa, 0001 |
Study Chair: | David S. Ettinger, MD | Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins | |
Principal Investigator: | Kathy S. Albain, MD | Loyola University | |
Study Chair: | David H. Johnson, MD | Vanderbilt-Ingram Cancer Center | |
Study Chair: | Bruce E. Johnson, MD | Dana-Farber Cancer Institute | |
Study Chair: | Mark R. Green, MD | Medical University of South Carolina | |
Study Chair: | Robert C. Miller, MD | Mayo Clinic | |
Study Chair: | Yvon Cormier, MD | L'Hopital Laval |
Other Publications:
Responsible Party: | Radiation Therapy Oncology Group |
ClinicalTrials.gov Identifier: | NCT00002550 |
Other Study ID Numbers: |
RTOG-9309 CDR0000063333 CAN-NCIC-BR13 CLB-9592 E-R9309 NCCTG-R9309 NCI-94-C-0043 SWOG-9336 INT-0139 |
First Posted: | April 10, 2003 Key Record Dates |
Last Update Posted: | November 17, 2015 |
Last Verified: | November 2015 |
squamous cell lung cancer large cell lung cancer stage IIIA non-small cell lung cancer adenocarcinoma of the lung bronchoalveolar cell lung cancer |
Lung Neoplasms Carcinoma, Non-Small-Cell Lung Respiratory Tract Neoplasms Thoracic Neoplasms Neoplasms by Site Neoplasms Lung Diseases Respiratory Tract Diseases Carcinoma, Bronchogenic |
Bronchial Neoplasms Etoposide Antineoplastic Agents Antineoplastic Agents, Phytogenic Topoisomerase II Inhibitors Topoisomerase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |