BACKGROUND: The purpose of the present study was to improve the prognosis of patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). To achieve that goal, we performed induction chemoradiotherapy followed by surgery. METHODS: The criteria for this phase II study were ≤75-year-old patients with pathologically diagnosed stage IIIA-N2 NSCLC who had performance statuses of 0 or 1 with good organ function. Three cycles of chemotherapy with paclitaxel and carboplatin were carried out, with concurrent hyperfractionated irradiation (42 Gy). After re-evaluation, pulmonary resections were considered unless patients showed progressive disease. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS) and absence of toxicity. RESULTS: All 22 patients enrolled in this study completed the induction chemoradiotherapy without any severe complications. In these 22 patients, the 2- and 5-year OS were 81 and 47%, respectively. There were no therapy-related deaths. Surgery was subsequently performed in 19 patients (86%). Pathological complete responses were seen in 6 patients (27%), while node downstaging was obtained in 10 patients (45%). In the 19 patients who underwent surgery, the 2- and 5-year OS rates were 83 and 62%, respectively, and the 2-year DFS rate was 63%. All 6 patients with pathological complete responses survived without disease. Patients with residual multiple-station N2 showed worse OS and DFS rates than did those with downstaged and single-station N2 (P=0.026 and P<0.0001, respectively). CONCLUSIONS: This trimodal therapy was effective and well tolerated, and it is an acceptable therapeutic option for patients with locally advanced stage IIIA-N2 NSCLC. Patients without persistent multiple-station N2 showed promising survival.
BACKGROUND: The purpose of the present study was to improve the prognosis of patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). To achieve that goal, we performed induction chemoradiotherapy followed by surgery. METHODS: The criteria for this phase II study were ≤75-year-old patients with pathologically diagnosed stage IIIA-N2 NSCLC who had performance statuses of 0 or 1 with good organ function. Three cycles of chemotherapy with paclitaxel and carboplatin were carried out, with concurrent hyperfractionated irradiation (42 Gy). After re-evaluation, pulmonary resections were considered unless patients showed progressive disease. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS) and absence of toxicity. RESULTS: All 22 patients enrolled in this study completed the induction chemoradiotherapy without any severe complications. In these 22 patients, the 2- and 5-year OS were 81 and 47%, respectively. There were no therapy-related deaths. Surgery was subsequently performed in 19 patients (86%). Pathological complete responses were seen in 6 patients (27%), while node downstaging was obtained in 10 patients (45%). In the 19 patients who underwent surgery, the 2- and 5-year OS rates were 83 and 62%, respectively, and the 2-year DFS rate was 63%. All 6 patients with pathological complete responses survived without disease. Patients with residual multiple-station N2 showed worse OS and DFS rates than did those with downstaged and single-station N2 (P=0.026 and P<0.0001, respectively). CONCLUSIONS: This trimodal therapy was effective and well tolerated, and it is an acceptable therapeutic option for patients with locally advanced stage IIIA-N2 NSCLC. Patients without persistent multiple-station N2 showed promising survival.
Authors: P Therasse; S G Arbuck; E A Eisenhauer; J Wanders; R S Kaplan; L Rubinstein; J Verweij; M Van Glabbeke; A T van Oosterom; M C Christian; S G Gwyther Journal: J Natl Cancer Inst Date: 2000-02-02 Impact factor: 13.506
Authors: David G Pfister; David H Johnson; Christopher G Azzoli; William Sause; Thomas J Smith; Sherman Baker; Jemi Olak; Diane Stover; John R Strawn; Andrew T Turrisi; Mark R Somerfield Journal: J Clin Oncol Date: 2003-12-22 Impact factor: 44.544
Authors: W Eberhardt; H Wilke; G Stamatis; M Stuschke; A Harstrick; H Menker; B Krause; M R Müeller; M Stahl; M Flasshove; V Budach; D Greschuchna; N Konietzko; H Sack; S Seeber Journal: J Clin Oncol Date: 1998-02 Impact factor: 44.544
Authors: C P Belani; J S Lee; M A Socinski; F Robert; D Waterhouse; K Rowland; R Ansari; R Lilenbaum; R B Natale Journal: Ann Oncol Date: 2005-04-28 Impact factor: 32.976
Authors: N C Choi; R W Carey; W Daly; D Mathisen; J Wain; C Wright; T Lynch; M Grossbard; H Grillo Journal: J Clin Oncol Date: 1997-02 Impact factor: 44.544
Authors: Mitchell Machtay; Jason H Lee; James P Stevenson; Joseph B Shrager; Kenneth M Algazy; Joseph Treat; Larry R Kaiser Journal: J Thorac Cardiovasc Surg Date: 2004-01 Impact factor: 5.209
Authors: K S Albain; V W Rusch; J J Crowley; T W Rice; A T Turrisi; J K Weick; V A Lonchyna; C A Presant; R J McKenna; D R Gandara Journal: J Clin Oncol Date: 1995-08 Impact factor: 44.544