CONCURRENT CISPLATIN ETOPOSIDE PLUS CHEST RADIOTHERAPY FOLLOWED BY SURGERY FOR STAGES IIIA(N2) AND IIIB NON-SMALL-CELL LUNG-CANCER - MATURERESULTS OF SOUTHWEST-ONCOLOGY-GROUP PHASE-II STUDY-8805/

Purpose: To assess the feasibility of concurrent chemotherapy and irra diation (chemoRT) Followed by surgery in locally advanced non-small-ce ll lung cancer (NSCLC) in ct cooperative group setting, and to estimat e response, resection rates, relapse patterns, and survival for stage subsets IIIA(N2) versus IIIB. Patients and Methods: Biopsy proof of ei ther positive N2 nodes (IIIAN) or of N3 nodes or T4 primary lesions (I IIB) was required. induction was two cycles of cisplatin and etoposide plus concurrent chest RT to 45 Gy. Resection was attempted if respons e or stable disease occurred, A chemoRT boost was given if either unre sectable disease or positive margins or nodes was found. Results: The median follow-up time for 126 eligible patients [75 stage IIIA(N2) and 51 IIIB] was 2.4 years. The objective response rate to induction was 59%, and 29% were stable. Resectability was 85% for the IIIA(N2) group eligible for surgery and 80% for the IIIB group. Reversible grade 4 t oxicity occurred in 13% of patients. There were 13 treatment-related d eaths (10%) and 19 others (15%) died of causes not related to toxicity or tumor. Of 65 relapses, 11% were only locoregional and 61% were onl y distant, There were 26 brain relapses, of which 19 were the sole sit e or cause of death. There was no survival difference (P = .81) betwee n stage IIIA(NZ) versus stage IIIB (median survivals, 13 and 17 months ; 2-year survival rates, 37% and 39%; 3-year survival rates, 27% and 2 4%). The stongest predictor of long-term survival after thoracotomy wa s absence of tumor in the mediastinal nodes at surgery (median surviva ls, 30 v 10 months; 3-year survival rates, 44% v 18%; P = .0005). Conc lusion: This trimodality approach was feasible in this Southwest Oncol ogy Group (SWOG) study, with an encouraging 26% 3-year survival rate. An intergroup study is currently being conducted to determine whether surgery adds more to the risk or to the benefit of chemoRT. J Clin Onc ol 73:1880-1892. (C) 1995 by American Society of Clinical Oncology.