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J Thorac Cardiovasc Surg 2001;121:472-483
© 2001 The American Association for Thoracic Surgery
General Thoracic Surgery |
From Thoracic Service,a Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Southwest Oncology Group Statistical Center,b Seattle, Wash; Division of Hematology Oncology,c Karmanos Cancer Center, Detroit, Mich; Department of Radiation Oncology,d Memorial Hospital, Colorado Springs, Colo; Division of Medical Oncology,e The Vanderbilt Clinic, Nashville, Tenn; Department of Surgery,f Fox Chase Cancer Center, Philadelphia, Pa; Cardiothoracic Surgery,g University of North Carolina, Chapel Hill, NC; Department of Medical Oncology and Hematology,h Princess Margaret Hospital, Toronto; Department of Medical Oncology,i Mount Sinai Hospital, Toronto; Department of Surgical Oncology,j Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Surgery,k Mayo Clinic, Rochester, Minn; Division of Oncology,l University of Washington, Seattle, Wash; and Department of Hematology/Oncology,m University of California Davis Cancer Center, Sacramento, Calif.
Received for publication May 3, 2000. Revisions requested Aug 1, 2000; revisions received Oct 11, 2000. Accepted for publication Oct 20, 2000. Address for reprints: Southwest Oncology Group Operations Office, 14980 Omicron Dr, San Antonio, TX 78245.
Objective: The rate of complete resection (50%) and the 5-year survival (30%) for non–small cell lung carcinomas of the superior sulcus have not changed for 40 years. Recently, combined modality therapy has improved outcome in other subsets of locally advanced non–small cell lung carcinoma. This trial tested the feasibility of induction chemoradiation and surgical resection in non–small cell lung carcinoma of the superior sulcus with the ultimate aim of improving resectability and survival.
Methods: Patients with mediastinoscopy-negative T3-4 N0-1 superior sulcus non–small cell lung carcinoma received 2 cycles of cisplatin and etoposide chemotherapy concurrent with 45 Gy of radiation. Patients with stable or responding disease underwent thoracotomy 3 to 5 weeks later. All patients received 2 more cycles of chemotherapy and were followed up by serial radiographs and scans. Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed for significance by Cox regression analysis.
Results: From April 1995 to September 1999, 111 eligible patients (77 men, 34 women) were entered in the study, including 80 (72.1%) with T3 and 31 with T4 tumors. Induction therapy was completed as planned in 102 (92%) patients. There were 3 treatment-related deaths (2.7%). Cytopenia was the main grade 3 to 4 toxicity. Of 95 patients eligible for surgery, 83 underwent thoracotomy, 2 (2.4%) died postoperatively, and 76 (92%) had a complete resection. Fifty-four (65%) thoracotomy specimens showed either a pathologic complete response or minimal microscopic disease. The 2-year survival was 55% for all eligible patients and 70% for patients who had a complete resection. To date, survival is not significantly influenced by patient sex, T status, or pathologic response.
Conclusions: (1) This combined modality treatment is feasible in a multi-institutional setting; (2) the pathologic complete response rates were high; and (3) resectability and overall survival were improved compared with historical experience, especially for T4 tumors, which usually have a grim prognosis.
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