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The Annals of Thoracic Surgery, Vol 47, 669-675, Copyright © 1989 by The Society of Thoracic Surgeons
LP Faber, CF Kittle, WH Warren, PD Bonomi, SG Taylor 4th, S Reddy and MS Lee
Surgical therapy for stage III non-small cell lung cancer (NSCLC) has not
resulted in substantial long-term survival. Neoadjuvant treatment programs
that could down-stage the tumor and achieve increased long- term survival
would be of obvious benefit. We have used preoperative simultaneous
chemotherapy and irradiation in 85 patients with clinical stage III
non-small cell lung cancer considered candidates for surgical resection.
One group of 56 patients was treated with cisplatin, 5- fluorouracil, and
simultaneous irradiation for five days every other week for a total of four
cycles. After treatment, 39 patients underwent resection, and the operative
mortality was 2 (5%) of 39. A second trial was undertaken in which
etoposide (VP-16) was added because of its synergism with cisplatin. In
this group, 29 patients were considered to have potentially resectable
disease, and 23 underwent thoracotomy with 1 operative death (4%). Of the
total of 62 patients having thoracotomy, 60 underwent resection (97%).
Complications were major, and there were four bronchopleural fistulas. For
the 85 patients eligible for surgical intervention in these two groups of
patients, the Kaplan-Meier median survival estimate is 40% at 3 years. The
median survival of the 62 patients having thoracotomy is 36.6 months.
Combination preoperative chemotherapy and irradiation is feasible with
acceptable toxicity and operative mortality in patients with clinical stage
III non-small cell lung cancer. Prospective randomized studies are
suggested for further evaluation of this treatment program.
ARTICLES
Preoperative chemotherapy and irradiation for stage III non-small cell lung cancer
Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
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