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J Thorac Cardiovasc Surg 2007;133:1179-1185
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Induction chemoradiotherapy (carboplatin-taxane and concurrent 50-Gy radiation) for bulky cN2, N3 non–small cell lung cancer

Hiroyasu Yokomise, MD*, Masashi Gotoh, MD, Taku Okamoto, MD, Yasumichi Yamamoto, MD, Shinya Ishikawa, MD, Takashi Nakashima, MD, Daiki Masuya, MD, Dage Liu, MD, Cheng-long Huang, MD

Second Department of Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Japan.

Received for publication August 6, 2006; revisions received November 21, 2006; accepted for publication December 12, 2006.

* Address for reprints: Hiroyasu Yokomise, MD, Second Department of Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan. (Email: yokomise{at}kms.ac.jp).

Objective: To improve the prognosis of cN2, N3 non–small cell lung cancer, we performed induction chemoradiotherapy (carboplatin-taxane chemotherapy and concurrent 50-Gy radiation) followed by surgery.

Methods: Patients with pathologically proven non–small cell lung cancer with bulky cN2, N3 disease were enrolled. Forty-one patients underwent an operation after chemoradiotherapy from January 2000 to April 2006. Either carboplatin-paclitaxel (n = 19) or carboplatin-docetaxel (n = 22) chemotherapy was randomly used. Two cycles of chemotherapy were performed with concurrent radiation (50 Gy). In all cases, conventional radiological reevaluations were performed; in the latest 21 cases, reevaluations with positron-emission tomography with fludeoxyglucose F 18 were also performed.

Results: In all 41 cases, complete resections were performed, with no operative mortality. The histologically complete response rate, major response rate, and minor response rate were 17.1% (7/41), 56.1% (23/41), and 26.8% (11/41), respectively. The 5-year overall survival was 52.7%. There were no differences in survival between taxane groups. Both the complete response and the major response groups revealed a significantly better 5-year survivals than the minor response group (85.7%, P = .044, 52.4%, P = .01). Even with persistent N2 disease, the 5-year survival in the major response group (66%) was promising. With the combination of conventional computed tomography and positron-emission tomography with fludeoxyglucose F 18 for reevaluation, eligible patients could be selected for this protocol.

Conclusion: Surgery after chemoradiotherapy (carboplatin-taxane and 50-Gy radiation) for bulky cN2, N3 non–small cell lung cancer can be safely performed with promising results. Even with persistent N2 disease, the survival in the major response group was promising.

Abbreviations and Acronyms CT = computed tomography; CD = carboplatin-docetaxel; CP = carboplatin-paclitaxel; EP = cisplatin-etoposide; FDG-PET = positron emission tomography with fludeoxyglucose F 18; NSCLC = non–small cell lung cancer; SUV = standardized uptake value




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