VALUE OF INDUCTION TREATMENT IN SURGERY F OR LOCALLY ADVANCED NON-SMALL-CELL CANCERS

From October 1988 to July 1990, 18 patients with marginally resectable non-small cell cancer (10 stage IIIa and 8 stage IIIb) were entered i n a phase-II trial combining induction therapy with a subsequent thora cotomy. Induction therapy included 2 courses of chemotherapy (5-FU and cisplatinum) and radiotherapy (30 Gray in split course). Partial resp onse was observed in 10 patients, and minimal response in 3. Thoracoto my disclosed unresectability in 3 patients. Fifteen complete resection s consisted in 1 lobectomy and 14 pneumonectomies. There were no opera tive deaths (30 days). Postoperative recovery was uneventful in 3 pati ents with exploratory thoracotomy and in 1 patient with lobectomy. Fol lowing pneumonectomy, we observed 2 bronchopleural fistulae and 1 empy ema. On pathology, 10 patients were stage IIIa, and 3 were stage I, wh ereas no residual tumor was found in 2 patients. During follow-up, loc al recurrence occurred in 2, and metastases in 8. On December 31st, 19 93, 3 patients were alive at 44, 52, and 62 months respectively. Nine patients had died from cancer, and 3 from unrelated causes. Estimated survival was 66.7% at 1 year, 33.3% at 3 years, and 20% at 5 years. We conclude that induction therapy allowed satisfactory resection for ma rginally resectable tumors. Operative morbidity was increased in this group. However, the 5-year survival was similar to resectable stage II Ia cancer.