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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 97-104, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
VW Rusch, KS Albain, JJ Crowley, TW Rice, V Lonchyna, R McKenna Jr, RB Livingston, BR Griffin and JR Benfield
Recent studies suggest that preoperative induction chemotherapy +/-
radiotherapy can improve the historically poor resectability and survival
of patients with stage IIIA non-small-cell lung cancer, but sometimes with
significant associated morbidity and mortality. Such treatment has not been
studied in stage IIIB non-small-cell lung cancer, usually considered
unresectable. This multiinstitutional phase II trial tested the feasibility
of concurrent preoperative chemoradiotherapy for stages IIIA and IIIB
non-small-cell lung cancer. Methods: Eligible patients had pathologically
documented T1-4 N2-3 disease (without pleural effusions). Induction therapy
was cisplatin, 50 mg/m2, days 1, 8, 29, and 36 plus VP-16, 50 mg/m2, days 1
to 5, and 29 to 33 plus concurrent radiotherapy (4500 cGy, 180 cGy
fractions). Resection was attempted 3 to 5 weeks after induction if the
response was stable, partial, or complete. Complete nodal mapping at
thoracotomy was required. Results: One hundred forty-six patients were
entered. This interim analysis is based on the first 75 eligible patients
for whom complete surgical data are available. There were 49 men and 26
women, median age 58 years (range 32 to 75 years). Sixty-eight of (91%)
patients were eligible for operation, and 63 of 75 patients (84%) underwent
thoracotomy. Fifty five of 75 patients (73%), including 12 of 16 with a
stable response, had a complete resection. Four of 63 patients died
postoperatively (6%). Approximately one third required a "complex"
resection, for example, lobectomy plus chest wall or spine resection, but
mean operating time was 3.2 hours and mean blood loss was less than 1000 ml
for both stages IIIA and IIIB. Complete pathology data are currently
available from 53 patients: 11 (21%) had no residual tumor; 20 (30%) had
rare microscopic foci of residual cancer. The 2- year survival is 40% for
both stages IIIA and IIIB. Conclusions: This combined modality therapy has
been well tolerated and has been associated with high response and
resectability rates in both stage IIIA and stage IIIB non-small-cell lung
cancer. Current survival is significantly better than survivorship among
historical control patients and provides a firm basis for subsequent phase
III clinical trials.
ARTICLES
Surgical resection of stage IIIA and stage IIIB non-small-cell lung cancer after concurrent induction chemoradiotherapy. A Southwest Oncology Group trial
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y. 10021.
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