ACCELERATED INDUCTION THERAPY AND RESECTION FOR POOR-PROGNOSIS STAGE-III NON-SMALL-CELL LUNG-CANCER

Background. Induction therapy and resection may improve the survival o f patients with poor prognosis stage III non-small cell lung cancer, a t the cost of significant treatment prolongation. The purpose of this study was to assess toxicity, response, and survival of an accelerated induction regimen and resection in poor prognosis stage III non-small cell lung cancer. Methods. Forty-two surgically staged patients with poor prognosis stage III non-small cell lung cancer received 11 days o f induction treatment consisting of 96 hours of continuous chemotherap y infusions of cisplatin (20 mg . m(-2). day(-2)), 5 fluorouracil (1,0 00 mg . m(-2). day(-2)), and etoposide (75 mg . m(-2). day(-2)) concur rent with accelerated fractionation radiation therapy (1.5 Gy twice a day, to a dose of 27 Gy). Induction was followed in 4 weeks by resecti on. Postoperatively, a second course of continuous chemotherapy and co ncurrent accelerated fractionation radiation therapy (postoperative do se 13 to 36 Gy) was given. Results. Despite some degree of induction t oxicity in all patients there was only one induction death (2.4%). A c linical partial response was seen in 24 patients (57%). Thirty-six pat ients (86%) underwent thoracotomy, and resection was possible in 33 (7 9%). Pathologic downstaging was seen in 17 patients (40%), and 2 patie nts (5%) had no residual carcinoma at operation. There were 11 postope rative complications (31%) and 4 postoperative deaths (11%). Thirteen patients (31%) are alive and disease-free, 24 (57%) have persistent di sease or have recurred (15 distant, 5 locoregional, 4 both), and 9 pat ients are alive with disease. The median survival is 21 months and the 2-year Kaplan-Meier survival is 43%, with no differences identified b etween stages IIIA and IIIB patients (p = 0.63). Conclusions. We concl ude that accelerated induction therapy and resection in poor prognosis stage III nonsmall cell lung cancer (1) is toxic, with a 12% treatmen t mortality; (2) is effective with a 79% resection rate and 40% pathol ogic downstaging rate; (3) provides excellent local control; (4) may p rolong survival; and (5) is of value in stage IIIB as well as stage II IA patients.