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The Annals of Thoracic Surgery, Vol 53, 992-998, Copyright © 1992 by The Society of Thoracic Surgeons
HI Pass, HW Pogrebniak, SM Steinberg, J Mulshine and J Minna
The role of neoadjuvant chemotherapy in stage IIIa non-small cell lung
cancer remains undefined. Since 1987, 27 patients with non-small cell lung
cancer, all with histologically confirmed metastases to the ipsilateral
mediastinal lymph nodes, have been enrolled in an ongoing prospective,
randomized trial at our institution. Thirteen patients have been randomized
to preoperative etoposide-platinum (EP) chemotherapy-surgery-postoperative
EP, and 14 other patients have been randomized to surgery-postoperative
mediastinal irradiation (SRT). Both groups are similar in sex, age, weight
loss, tumor location, preoperative pulmonary function, physiologic grade,
and tumor histology. Eight of the 13 EP patients have responded as
evidenced by a 50% or greater radiographic tumor shrinkage after two
cycles. Complete tumor and nodal resection rates were similar: 11/13 EP
patients versus 12/14 SRT patients. There was no operative mortality for
the 27 patients. Median potential follow-up is 29.9 months for the EP group
and 34.9 months for the SRT group. Preliminary results suggest a trend
toward increased survival time for the EP group (median, 28.7 months)
versus the SRT group (median, 15.6 months) (p2 = 0.095). Eleven of 12
resected SRT patients have had recurrence versus 8 of 11 resected EP
patients. Time to recurrence reveals no significant differences between the
two groups but a trend toward increased disease-free interval in the EP
group (12.7 months versus 5.8 months, EP versus SRT). This interim analysis
demonstrates the feasibility of such a trial; however, despite the trends,
definitive conclusions await further accrual and study maturation.
ARTICLES
Randomized trial of neoadjuvant therapy for lung cancer: interim analysis
Thoracic Oncology Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892.
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N. Van Zandwijk, E. F. Smit, G. W. P. Kramer, F. Schramel, S. Gans, J. Festen, A. Termeer, N. J. J. Schlosser, C. Debruyne, D. Curran, et al. Gemcitabine and Cisplatin as Induction Regimen for Patients With Biopsy-Proven Stage IIIA N2 Non-Small-Cell Lung Cancer: A Phase II Study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group (EORTC 08955) J. Clin. Oncol., July 14, 2000; 18(14): 2658 - 2664. [Abstract] [Full Text] [PDF]
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P. A. Bunn Jr, J. Mault, and K. Kelly Adjuvant and Neoadjuvant Chemotherapy for Non-Small Cell Lung Cancer : A Time for Reassessment? Chest, April 1, 2000; 117 (2009): 119S - 122S. [Abstract] [Full Text] [PDF]
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J. R. Sonett, M. J. Krasna, M. Suntharalingam, J. Schuetz, L. A. Doyle, R. Lilenbaum, and Z. Gamliel Safe pulmonary resection after chemotherapy and high-dose thoracic radiation Ann. Thorac. Surg., August 1, 1999; 68(2): 316 - 320. [Abstract] [Full Text] [PDF]
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P. De Leyn, J. Vansteenkiste, G. Deneffe, D. Van Raemdonck, W. Coosemans, and T. Lerut Result of induction chemotherapy followed by surgery in patients with stage IIIA N2 NSCLC: importance of pre-treatment mediastinoscopy Eur. J. Cardiothorac. Surg., May 1, 1999; 15(5): 608 - 614. [Abstract] [Full Text] [PDF]
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J. Vansteenkiste, P. De Leyn, G. Deneffe, J. Menten, T. Lerut, and M. Demedts Present status of induction treatment in stage IIIA-N2 non-small cell lung cancer: a review Eur. J. Cardiothorac. Surg., January 1, 1998; 13(1): 1 - 12. [Abstract] [Full Text] [PDF]
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L. H. Einhorn Neoadjuvant and Adjuvant Trials in Non-Small Cell Lung Cancer Ann. Thorac. Surg., January 1, 1998; 65(1): 208 - 211. [Abstract] [Full Text] [PDF]
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J. D. Lee and R. J. Ginsberg Lung Cancer Staging: The Value of Ipsilateral Scalene Lymph Node Biopsy Performed at Mediastinoscopy Ann. Thorac. Surg., August 1, 1996; 62(2): 338 - 341. [Abstract] [Full Text]
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J. Olak and A. Ng Diagnosis and Treatment of Early-Stage Non-Small Cell Lung Cancer Oncologist, August 1, 1996; 1(4): 201 - 209. [Abstract] [Full Text] [PDF]
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