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Ann Thorac Surg 1995;60:591-592
© 1995 The Society of Thoracic Surgeons

Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 586.

DR VALERIE W. RUSCH (New York, NY): I congratulate Dr Rice on an excellent presentation and thank him for sending me the manuscript to review in advance of the meeting. His study builds on a long series of neoadjuvant therapy trials reported during the past decade, all of which have tried to improve the poor prognosis of patients with stage III non–small cell lung cancer. I have a few comments about the trial that I hope will place it in perspective.

Neoadjuvant trials have used three treatment strategies: preoperative chemotherapy and radiation followed by surgical resection; preoperative chemotherapy alone followed by surgical resection; or chemotherapy followed by radiation without surgical resection. However, all trials recognize that the poor prognosis of stage III non–small cell lung cancer relates to the frequent development of distant metastases and that the pivotal part of neoadjuvant therapy is the use of high-dose chemotherapy.

Overall, neoadjuvant trials, both randomized and nonrandomized, have shown response and resectability rates of 50% to 75% and survival rates that appear to be superior to those seen with surgical resection or radiation alone.

The principal aim of this trial, namely to shorten the length of induction treatment while trying to preserve therapeutic intensity, is laudable and the regimen used is a novel variation on previous regimens. However, the toxicity of the induction regimen is significant; 19% of patients experienced grade III or IV esophagitis and 69% of patients developed grade IV . . . [Full Text of this Article]






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Copyright © 1995 by The Society of Thoracic Surgeons.