Concurrent Chemoradiation in Locally Advanced Lung Cancer with Cisplatin–Etoposide or Carboplatin–Paclitaxel: An Institutional Analysis

Concurrent chemoradiation (cCRT) is standard for unresectable, locally advanced non–small cell lung cancer (NSCLC), but the preferred concurrent chemotherapy backbone is uncertain. Cisplatin–etoposide (EP) and weekly carboplatin–paclitaxel (PC) are commonly used. Background/Objectives: Retrospective single-institution cohort of adults with histologically confirmed, inoperable AJCC stage II–III NSCLC treated 2015–2023 with definitive thoracic radiation plus concurrent EP or PC. Methods: We collected clinical characteristics, treatment completion, best radiographic response, adverse events (AEs), progression, and death. Primary endpoints were progression-free survival (PFS) and overall survival (OS); secondary endpoints were overall response rate (ORR) and AEs. Kaplan–Meier survival estimates were generated and compared using log-rank testing; hazard ratios (HRs) were estimated using Cox proportional hazards models. Results: Among 177 patients (EP, n = 43; PC, n = 134), stage III disease comprised 91% in the EP cohort and 90% in the PC cohort. ORR favored EP (63% vs 52%), and primary progressive disease as best response was less frequent with EP (7% vs 21%, p = 0.04). Median PFS was 48.07 vs 14.93 months (HR 0.65, 95% CI 0.43–0.90; p = 0.05). Median OS numerically favored EP (76.97 vs 34.60 months; HR 0.70, 95% CI 0.44–1.12; p = 0.17). Any-grade AEs occurred at similar rates (34.9% vs 34.3%), whereas grade 3–4 AEs were more frequent with EP (25.6% vs 9.7%; p = 0.02). Conclusion: EP-based cCRT was associated with longer PFS and higher grade 3–4 toxicity than PC; findings support individualized selection and need validation, especially in the immunotherapy era.