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Right arrow Lung - cancer

J Thorac Cardiovasc Surg 2001;122:796-802
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery

Benefit of surgery after chemoradiotherapy in stage IIIB (T4 and/or N3) non–small cell lung cancer

Dominique H. Grunenwald, MDa, Fabrice André, MDb, Cécile Le Péchoux, MDc, Philippe Girard, MDa, Christian Lamer, MDd, Agnès Laplanche, MDe, Michèle Tarayre, e, Rodrigo Arriagada, MDc, Thierry Le Chevalier, MDb

From the Thoracic Department, Institut Mutualiste Montsouris,a Paris; the Departments of Medicineb and Radiotherapy,c Institut Gustave Roussy, Villejuif; the Intensive Care Unit, Institut Mutualiste Montsouris,d Paris; and the Department of Biostatistics,e Institut Gustave Roussy, Villejuif, France.

Received for publication Dec 20, 2000. Revisions requested Feb 27, 2001; revisions received March 27, 2001. Accepted for publication April 13, 2001. Address for reprints: D. H. Grunenwald, MD, Head, Thoracic Department, Institut Mutualiste Montsouris, 42 bld Jourdan, 75674 Paris cedex 14, France (E-mail: thorax{at}imm.fr).

Objective: The purpose of this study was to evaluate postchemoradiotherapy surgery in stage IIIB non–small cell lung cancer.
Methods: Forty patients with stage IIIB non–small cell lung cancer were included in this phase II study. A preoperative diagnosis of stage IIIB cancer was based on mediastinoscopy or a thoracotomy in all patients. Induction treatment included two cycles of cisplatin (100 mg/m2, day 1), 5-fluorouracil (1 g/m2, days 1-3), and vinblastine (4 mg/m2, day 1) combined with 42 Gy of hyperfractionated radiotherapy delivering 21 Gy in two sessions. Patients with a clinical response were offered surgery.
Results: The minimum follow-up for survivors was 48 months. Thirty patients had a T4 lesion and 18 had N3 disease. Twenty-nine patients (73%) had a clinical objective tumor response after induction treatment. These 29 patients underwent thoracotomy, and a complete resection was performed in 23 (58%). Two postoperative deaths occurred (7%). Four patients had a pathologic complete response at the time of surgery (10%). The 5-year survival is 19% for the overall population. When only patients who had persistent viable tumor cells at surgery are considered (n = 25), the 5-year survival is 28%. The 5-year survival is 42% for patients having no mediastinal lymph node involvement at the time of surgery and being treated with complete resection.
Conclusion: This study shows that surgery, when feasible, is associated with a 28% long-term survival for patients in whom chemoradiotherapy alone fails to control disease.




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