Non-Small Cell Lung Cancer · Radiation · Locally Advanced / Resectable

RTOG 9410

For unresectable stage III NSCLC, does concurrent chemoradiotherapy improve survival compared with sequential chemoradiotherapy?

Trial design and population

Population / eligibility

610 patients with inoperable stage III NSCLC randomized to sequential or concurrent cisplatin-based chemoradiotherapy.

Intervention vs comparator

Sequential chemotherapy then RT vs concurrent cisplatin-based chemotherapy with thoracic RT (60 Gy in the once-daily concurrent arm).

Sample size

610

Primary endpoint

Overall survival

Key results

Median OS was 17.0 months with once-daily concurrent CRT vs 14.6 months with sequential treatment; 5-year OS was 16% vs 10% (P=.046). Concurrent therapy increased acute esophageal toxicity.

Source-reported outcome visualization

5-year overall survival · 5 years

Concurrent CRT

16 %

Sequential CRT

10 %

Bars are scaled to the larger reported group value; endpoint, unit and horizon are labelled. Values are source-reported, not estimated from medians.

Absolute Effect

Absolute 5-year OS difference 6 percentage points; NNT 17 based on 5-year OS. Grade 3+ esophagitis was approximately 22% vs 4%, an 18-point excess; NNH 6 based on grade 3+ esophagitis.

NNT: 17 (5-year OS). Use only at the stated endpoint/time horizon; median survival differences are not converted into NNT.

NNH: ≈6 based on grade 3+ esophagitis during treatment. Grade 3+ esophagitis about 22% vs 4%; NNH ≈6 based on grade 3+ esophagitis. Severe pulmonary and hematologic toxicity and treatment-related deaths also matter.

Time-to-event hazard ratios and median survival are not treated as absolute risk differences. Where no defensible fixed-time NNT/NNH is available, the source-reported endpoint is visualized instead.

Safety and treatment burden

Grade 3+ esophagitis about 22% vs 4%; NNH ≈6 based on grade 3+ esophagitis. Severe pulmonary and hematologic toxicity and treatment-related deaths also matter.

Follow-up, maturity and limitations

Follow-up: Mature long-term follow-up.

Older chemotherapy and RT techniques. Contemporary stage III care often includes consolidation immunotherapy after concurrent CRT; RTOG 9410 established concurrent over sequential CRT, not the full modern regimen.

Clinical interpretation

Concurrent CRT improves long-term survival versus sequential CRT in fit stage III NSCLC patients, at the cost of greater acute esophageal toxicity.

Current-practice context · reviewed 20 October 2026

This page separates the original trial findings from contemporary treatment sequencing. Confirm current guidelines, local regulatory status, biomarker requirements, prior treatment exposure and patient-specific contraindications before applying the evidence. Historical comparators may no longer represent the current standard; subgroup findings and immature endpoints are labelled rather than generalized.

Primary and authoritative sources

Curran WJ Jr, et al. Sequential vs Concurrent Chemoradiation for Stage III NSCLC. J Natl Cancer Inst. 2011. Source ↗

ClinicalTrials.gov NCT00002576 Source ↗