PREOPERATIVE CONCURRENT CHEMORADIOTHERAPY FOR UNRESECTABLE STAGE-III NONSMALL CELL LUNG-CANCER

Purpose: We carried out a Phase II trial in an attempt to improve rese ctability and survivability of inoperable Stage III A and III B nonsma ll cell lung cancer (NSCLC) patients by implementing a neoadjuvant che moradiotherapy treatment program. Methods and Materials: Thirty-six pa tients with locally advanced Stage III NSCLC received neoadjuvant ther apy consisting of 50.4 Gy in 5.5 weeks concurrent with two cycles of c hemotherapy, using cisplatin and etoposide. No postsurgical consolidat ion therapy was given. Results: Assessment at 3 to 6 weeks after treat ment suggested that 26 (72%) patients had been rendered resectable. To xicities were common but usually tolerable; however, one toxic death o ccurred. Of 24 patients who proceeded to thoracotomy, complete resecti on was achieved in 20 (56%). There were two surgically related deaths. Surgical-pathological staging showed downstaging in 18 patients, incl uding complete sterilization of the tumor in 3 (8%). The median surviv al for all 36 patients is 15 months, but at the time of analysis, medi an survival of resectable patients had not been reached. The actuarial 2-year survival is 39% for all study groups, 57% for resectable patie nts, and 16% far the remaining (p < 0.005). Conclusions: While this pr eoperative neoadjuvant appears to improve survival of patients with St age III NSCLC, comparison with previous reports of other similar trial s indicate a superior survival advantage in association with higher do ses of radiotherapy.