Induction chemotherapy for stage IIIA unresectable non-small cell lung cancer: the Toronto experience and an overview.

Thirty-nine patients with mediastinoscopy stage IIIA, N2 non-small cell lung cancer received two cycles of MVP (mitomycin C, vindesine, cisplatin). Responders underwent thoracotomy for resection and two further courses of MVP. Overall response rate was 64% (25/39) with three complete and 22 partial responses. Twenty-two patients were resected, which included radical mediastinal node dissection. Eighteen resections were complete and four were incomplete. Pathologically, three patients (7.7%) had no remaining tumor. Toxicity included two postoperative deaths with B-P fistula, mitomycin pulmonary toxicity in two patients, and four septic deaths. Twenty-eight patients have died, 20 with recurrent or progressive disease. Of the 18 patients completely resected, eight have recurred with a median time to recurrence of 20.6 months. Sites of recurrence include two locoregional, five distant (two in brain) and one in both. Median survival of the entire 39 patients is 18.6 months, with a three year survival of 26%. The median survival for those patients completely resected was 29.7 months with a 3-year survival of 40%.