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Right arrow Lung - cancer

Ann Thorac Surg 2003;75:1107-1112
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

A phase II single-institution study of neoadjuvant stage IIIA/B chemotherapy and radiochemotherapy in non-small cell lung cancer

Andreas Granetzny, MDa*, Eberhard Striehn, MDa, Ulrich Bosse, MDb, Wolfgang Wagner, MDc, Olaf Koch, MDd, Ulf Vogt, PhDe, Peter Froeschle, MDa,b,c,d,e,f, Folker Klinke, MDf

a Department of Thoracic Surgery, Ostercappeln, Germany
b Institute of Pathology, Osnabrueck, Germany
c Department of Radiation Therapy, Osnabrueck, Germany
d Department of Hematology and Oncology, Osnabrueck, Germany
e European Laboratory Association, Ibbenbueren, Germany
f Department of Thoracic Surgery, Duisburg, Germany

Accepted for publication November 1, 2002.

* Address reprint requests to Dr Granetzny, Department of Thoracic Surgery, Evangelisches Krankenhaus Duisburg-Nord, Fahrner Str. 133, Duisburg 47169, Germany
e-mail: andreas.granetzny{at}ejk.de

BACKGROUND: The relevance of a trimodal strategy in the treatment of lung cancer, consisting of neoadjuvant radiochemotherapy followed by surgery, is a subject of ongoing clinical trials. We tested whether improvement of long-term survival can be achieved for patients with stage III non-small cell lung cancer by this therapeutic approach.

METHODS: We performed a retrospective analysis of a single-institution phase II study. Of 33 patients enrolled in the protocol between 1992 and 1995, we reviewed the clinical outcomes of 26 patients with locally advanced non-small cell lung cancer (stage IIIA and IIIB), which had been resected after combined chemotherapy and radiochemotherapy.

RESULTS: After neoadjuvant therapy, resection of the tumor was accomplished in all patients, and R0 resection was achieved in 92%. Histologic remission was found in 76% of these patients. Involvement of mediastinal lymph nodes was crucially important for the outcome. First, histologic clearance of the mediastinal compartment by neoadjuvant therapy resulted in a 27% 5-year survival rate. Second, patients with viable tumor in any of the mediastinal lymph nodes removed had a poor outcome (median survival 11.4 and 34.7 months in patients with and without viable tumor cells in the specimens, respectively; p = 0.01).

CONCLUSIONS: Histopathologic regression after neoadjuvant multimodal therapy including chemotherapy and radiotherapy was an important prognostic factor in a selected group of patients with locally advanced lung cancer.






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