BACKGROUND: We have previously demonstrated that high-dose chemoradiotherapy followed by resection for patients selected on the basis of mediastinal sterilization was feasible and resulted in excellent outcomes. This study was designed to determine the ability to intensify our prior approach utilizing hyperfractionated radiation and more aggressive consolidative chemotherapy. METHODS: Patients with documented stage IIIA/B nonsmall-cell lung cancer, performance status 0 to 2, and adequate organ function were eligible. A phase I portion utilized escalating doses of carboplatin and vinorelbine, commencing with areas under the curve of 1 and 5 mg/m(2), respectively, and concurrent 69.6 Gy hyperfractionated radiotherapy. A phase II portion utilized the identical radiotherapy with carboplatin/vinorelbine at the maximum tolerated dose established in phase I. Patients for whom mediastinal nodal clearance was demonstrated underwent resection. All patients were to receive consolidation chemotherapy consisting of carboplatin/vinorelbine for three cycles, followed by docetaxel for three cycles. Prophylactic cranial irradiation was offered to patients after completion of therapy. RESULTS: Forty-seven patients participated in the study (33 IIIA, 14 IIIB; 15 men, 32 women; median age, 56 years). The maximum tolerated dose for concurrent carboplatin/vinorelbine and hyperfractionated radiotherapy was established at areas under the curve of 1 and 10 mg/m(2), respectively. Twenty-eight patients completed trimodality treatment including surgery. Median survival time for the entire study cohort (n = 47) is 29.6 months, and it is 55.8 months for patients with mediastinal clearance who underwent resection (n = 28). CONCLUSIONS: Surgical resection of locally advanced stage IIIA and IIIB nonsmall-cell lung cancer after induction hyperfractionated radiation and concurrent chemotherapy is safe and well tolerated. Whether this approach is superior to less aggressive therapy is uncertain and will require comparative studies.
BACKGROUND: We have previously demonstrated that high-dose chemoradiotherapy followed by resection for patients selected on the basis of mediastinal sterilization was feasible and resulted in excellent outcomes. This study was designed to determine the ability to intensify our prior approach utilizing hyperfractionated radiation and more aggressive consolidative chemotherapy. METHODS:Patients with documented stage IIIA/B nonsmall-cell lung cancer, performance status 0 to 2, and adequate organ function were eligible. A phase I portion utilized escalating doses of carboplatin and vinorelbine, commencing with areas under the curve of 1 and 5 mg/m(2), respectively, and concurrent 69.6 Gy hyperfractionated radiotherapy. A phase II portion utilized the identical radiotherapy with carboplatin/vinorelbine at the maximum tolerated dose established in phase I. Patients for whom mediastinal nodal clearance was demonstrated underwent resection. All patients were to receive consolidation chemotherapy consisting of carboplatin/vinorelbine for three cycles, followed by docetaxel for three cycles. Prophylactic cranial irradiation was offered to patients after completion of therapy. RESULTS: Forty-seven patients participated in the study (33 IIIA, 14 IIIB; 15 men, 32 women; median age, 56 years). The maximum tolerated dose for concurrent carboplatin/vinorelbine and hyperfractionated radiotherapy was established at areas under the curve of 1 and 10 mg/m(2), respectively. Twenty-eight patients completed trimodality treatment including surgery. Median survival time for the entire study cohort (n = 47) is 29.6 months, and it is 55.8 months for patients with mediastinal clearance who underwent resection (n = 28). CONCLUSIONS: Surgical resection of locally advanced stage IIIA and IIIB nonsmall-cell lung cancer after induction hyperfractionated radiation and concurrent chemotherapy is safe and well tolerated. Whether this approach is superior to less aggressive therapy is uncertain and will require comparative studies.
Authors: Stephen R Broderick; Aalok P Patel; Traves D Crabtree; Jennifer M Bell; Daniel Morgansztern; Clifford G Robinson; Daniel Kreisel; A Sasha Krupnick; G Alexander Patterson; Bryan F Meyers; Varun Puri Journal: Ann Thorac Surg Date: 2015-09-26 Impact factor: 4.330
Authors: Ali Osman Kaya; Suleyman Buyukberber; Mustafa Benekli; Ugur Coskun; Alper Sevinc; Muge Akmansu; Ramazan Yildiz; Banu Ozturk; Emel Yaman; Mehmet Emin Kalender; Okan Orhan; Deniz Yamac; Aytug Uner Journal: Med Oncol Date: 2009-02-26 Impact factor: 3.064
Authors: Kevin X Liu; Kailan Sierra-Davidson; Kevin Tyan; Lawrence T Orlina; J Paul Marcoux; Benjamin H Kann; David E Kozono; Raymond H Mak; Abby White; Lisa Singer Journal: Radiother Oncol Date: 2021-10-22 Impact factor: 6.280
Authors: Wenhua Liang; Kaican Cai; Chun Chen; Haiquan Chen; Qixun Chen; Junke Fu; Jian Hu; Tao Jiang; Wenjie Jiao; Shuben Li; Changhong Liu; Deruo Liu; Wei Liu; Yang Liu; Haitao Ma; Xiaojie Pan; Guibin Qiao; Hui Tian; Li Wei; Yi Zhang; Song Zhao; Xiaojing Zhao; Chengzhi Zhou; Yuming Zhu; Ran Zhong; Feng Li; Rafael Rosell; Mariano Provencio; Erminia Massarelli; Mara B Antonoff; Toyoaki Hida; Marc de Perrot; Steven H Lin; Massimo Di Maio; Antonio Rossi; Dirk De Ruysscher; Robert A Ramirez; Wolfram C M Dempke; D Ross Camidge; Nicolas Guibert; Raffaele Califano; Qi Wang; Shengxiang Ren; Caicun Zhou; Jianxing He Journal: Transl Lung Cancer Res Date: 2020-12
Authors: Melissa A L Vyfhuis; Neha Bhooshan; Whitney M Burrows; Michelle Turner; Mohan Suntharalingam; James Donahue; Elizabeth M Nichols; Josephine Feliciano; Søren M Bentzen; Shahed Badiyan; Shamus R Carr; Joseph Friedberg; Charles B Simone; Martin J Edelman; Steven J Feigenberg; Pranshu Mohindra Journal: Adv Radiat Oncol Date: 2017-07-31