Optimization of Treatment of Advanced Nonsmall Cell Lung Cancer Using Radiotherapy and Chemotherapy

To compare survival rates (median and 1-year), and toxicity of two treatment regimens in patients with locally advanced incurable NSCLC (study A), to compare survival rates (median and 1-year) of two treatment regimens in patients with locally advanced and metastatic NSCLC (study B)

To compare HRQoL and cost effectiveness of two treatment regimens in patients with locally advanced incurable NSCLC (study A), and in patients with locally advanced and metastatic NSCLC (study B) and to evaluate the effect of HRQoL assessment on QoL dimensions

Study A Inclusion Criteria:

• Histologically or cytologically confirmed NSCLC
• Stage IIIA/IIIB staged with
• CT chest and upper abdomen
• Liver, renal, hematological reserve appropriate (according to "standard" institutional values)
• Brain CT and/or bone scan only if clinical symptoms request such investigation
• Performance status KPS 60-90
• No second cancer except skin non-melanoma
• No previous treatment
• Patient must be contactable for follow-up
• Patient to be able to start treatment within 2 weeks from randomization (institutional confirmation needed)
• Life expectancy > 3 months
• Patient must be able and willing to give informed consent, and fill in questionnaires

Study A Exclusion Criteria:

• Stage III B "wet" (existing pleural effusion , but not necessarily cytologically verified)
• RT field > 200 cm2
• Pregnancy

Study B Inclusion Criteria:

• KPS 60-90
• Stage IV and Stage III B (existing pleural effusions , but not necessarily cytologically verified)
• Histologically or cytologically confirmed
• CT staged disease (thorax and possible upper abdomen)
• No second cancer except skin non-melanoma
• Liver, renal, haematological reserve appropriate (according to "standard" institutional values)
• No previous treatment
• Patient must be contactable for follow-up
• Patient must be able and willing to give informed consent and fill in questionnaires
• Patient to be able to start treatment within 2 weeks from randomization (institutional confirmation needed)
• Life expectancy > 3 months

Study B Exclusion Criteria:

• Brain metastasis (brain CT and/or MRI not needed, unless symptoms exist - clinically indicated)
• RT field > 200 cm2
• Pregnancy
• A-P separation too large to be adequately treated with 60-Co (?)