Pl. Weiden et S. Piantadosi, PREOPERATIVE CHEMOTHERAPY (CISPLATIN AND FLUOROURACIL) AND RADIATION-THERAPY IN STAGE-III NONSMALL CELL LUNG-CANCER - A PHASE-2 STUDY OF THE LCSG, Chest, 106(6), 1994, pp. 190000344-190000347
Study objective: To determine the feasibility, toxicity, and potential
efficacy of neoadjuvant chemoradiotherapy before surgery in patients
with non-small cell lung cancer limited to the chest. Design: Phase 2
pilot study. Setting: Multi-institutional, multimodality cooperative g
roup. Patients: Eight-five patients with advanced stage III-A or minim
al stage III-B non-small cell lung cancer in whom attempted resection
would have been likely to leave residual disease. Intervention: Cispla
tin, 75 mg/m(2), was given on days 1 and 29; fluorouracil, 1 g/m(2) fo
r 24 h, was given as a continuous infusion on days 1 to 4 and 29 to 32
; thoracic radiation, 30 Gy in 15 fractions, was administered on days
1 to 19. Thoracotomy with tumor resection was planned for day 57. Meas
urements and results: Two patients achieved a complete and 46 achieved
a partial response after the neoadjuvant chemoradiotherapy for an ove
rall response rate of 56%. Toxicity was moderate but acceptable. Fifty
-four patients underwent thoracotomy and tumor resection was attempted
in 44; 29 (34%) had complete and 15 (18%) had incomplete resections.
There was no apparent increase in postoperative complications. In eigh
t patients (9%), no viable tumor was detected pathologically in the re
section specimen. Of the 18 patients whose tumors were completely rese
cted and had disease recurrence, none had recurrence only in the chest
, 15 (83%) had recurrence in distal sites, and 3 (17%) developed secon
d primary tumors. Median survival of all patients was 13 months. Concl
usions: This neoadjuvant regimen did not appear to provide major benef
it in patients with advanced but potentially resectable non-small cell
lung cancer. Further studies are needed to better define the relative
roles of preoperative radiotherapy and chemotherapy.