ASSESSMENT OF PREOPERATIVE ACCELERATED RADIOTHERAPY AND CHEMOTHERAPY IN STAGE IIIA (N2) NON-SMALL-CELL LUNG-CANCER

Forty patients with N2 non-small-cell lung cancer (stage IIIA), as det ermined by mediastinoscopy, were entered into a preoperative neoadjuva nt study of chemotherapy (platinum, 5-fluorouracil, vinblastine) and a ccelerated radiotherapy (150 cGy twice per day for 7 days) for two cyc les. Surgical resection was then performed and followed up with an add itional cycle of chemotherapy and radiotherapy. All patients completed preoperative therapy. A major clinical response was seen in 87% of pa tients. Thirty-five patients underwent resection (one preoperative dea th, one refused operation, one had deterioration of pulmonary function , and two had pleural metastases). Operative mortality rate was 5.7% ( 2/35). Sixty percent of patients had no complications. Major complicat ions included pulmonary emboli (three), pneumonia (two), and myocardia l infarction (one). Down-staging was seen in 46% of patients, with two patients (5.7%) having no evidence of tumor in the specimen, five pat ients having sterilization of all lymph nodes, and nine patients havin g sterilization of mediastinal nodes but positive N1 nodes. Median sur vival of 40 patients was 28 months, with a projected 5-year survival o f 43%. Patients with downstaged disease had statistically significant improved survival compared with patients whose disease was not downsta ged.