Pilot study of induction therapy with cyclophosphamide, doxorubicin, and cisplatin (CAP) and chest irradiation prior to thoracotomy in initially inoperable stage III M0 non-small cell lung cancer.

In an attempt to increase the resection rate of patients with non-small cell lung cancer, two cycles of cyclophosphamide, doxorubicin, and cisplatin chemotherapy and chest irradiation (3000 cGy in 10 fractions, split course) were administered to 42 initially inoperable (T3 or N2M0) patients. Three patients were subsequently determined to be ineligible, two because of small cell histology and one because of M1 disease. Among the 39 eligible patients, 20 (51%) had a regression following the combined-modality therapy. Seventeen of these patients plus two with stable disease had thoracotomy. Complete surgical resection was accomplished in 13 patients (33% of all eligible 39 patients; 68% of all 19 patients who had thoracotomy). There were no statistically significant survival differences between patients not having thoracotomy and those who had thoracotomy (or even those with complete tumor excision). The patients with chemotherapy, chest irradiation, and surgical resection had a low incidence of local in-chest failure (5%), but distant failure was still a major problem.