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J Thorac Cardiovasc Surg 2003;126:25-27
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Discussion

Dr Robert Ginsberg (Toronto, Ontario, Canada). I would like to congratulate Dr DeCamp and colleagues on a beautifully presented study. I have a few comments.

The title of the talk appears to assert that this induction chemoradiotherapy improves survival. I’m not sure that this has been proved, because there are no valid data for comparison. Be that as it may, I have a few questions for Dr DeCamp.

First, having had the experience of being in the SWOG study, was there any difference in selection of your patients with positive mediastinal lymph nodes? In other words, did you accept patients with single-station lymph node disease? If so, how many were there? Only 105 patients in a 6-year period were entered into this trial. What happened to the other patients with stage IIIA and IIIB disease at your institution during this time? How often was there multistation bulky nodal disease among your patients?

When you compare your data with those of SWOG to conclude that this accelerated chemoradiation improves survival, I have some questions. In your induction therapy all patients necessarily had to be hospitalized for their infusion, and 40% also had to be hospitalized because of toxicity. This occurred before the operation in the induction phase and after the operation in the adjuvant phase. Please comment on that and its comparison with the SWOG 4-week chemoradiation preoperative protocol. When you add up the figures, your protocol is a 12-week protocol, and many induction chemoradiation protocols nowadays are 4 to 5 weeks of induction chemoradiation followed by a 3- to 4-week rest, followed by surgery. That’s a 10-week protocol.

Your resectability figures were unchanged, your patient compliance figures were unchanged, and your downstaging was unchanged relative to the SWOG trial—a very simple protocol, and the time of treatment, even though it . . . [Full Text of this Article]