Comparative Evaluation of Concurrent Carboplatin-Paclitaxel Versus Cisplatin-Etoposide Chemoradiotherapy in Unresectable Non-small Cell Lung Cancer: A Prospective Randomized Study.

BACKGROUND

Concurrent chemoradiotherapy (CCRT) is the standard treatment for patients with unresectable non-small cell lung cancer (NSCLC). Cisplatin-etoposide (EP) and weekly carboplatin-paclitaxel (PC) are commonly used concurrent regimens, but comparative data on efficacy and toxicity remain limited. This study compared acute treatment-related toxicities and tumor response between these regimens, with six- and 12-month progression-free survival (PFS) and overall survival (OS) evaluated as pre-specified exploratory secondary outcomes.

MATERIALS AND

METHODS

This prospective randomized study included 34 patients with histologically confirmed unresectable NSCLC treated between April 2021 and June 2022. Patients received either EP (n=16) or PC (n=18) concurrently with definitive radiotherapy (60 Gy in 30 fractions). Acute toxicities and three-month tumor response were evaluated. Kaplan-Meier PFS and OS were estimated separately through six and 12 months in 31 evaluable patients, with horizon-specific log-rank and Cox analyses.

RESULTS

EP produced significantly more severe anemia, thrombocytopenia, and esophagitis, whereas pneumonitis was numerically more frequent with PC. The tumor-response distribution favored EP (p=0.029). Six-month PFS was 66.7% with EP and 56.3% with PC (p=0.499), and 12-month PFS was 40.0% and 25.0%, respectively (p=0.206). Six-month OS was 93.3% with EP and 81.3% with PC (p=0.317), and 12-month OS was 80.0% and 56.3%, respectively (p=0.144).

CONCLUSIONS

EP was associated with a more favorable tumor-response distribution and numerically better one-year PFS and OS than PC, but the survival differences were not statistically significant. These potential efficacy benefits were accompanied by greater hematological and esophageal toxicity.