MULTIMODALITY THERAPY OF PATIENTS WITH STAGE-IIIA, N2 NON-SMALL-CELL LUNG-CANCER - IMPACT OF PREOPERATIVE CHEMOTHERAPY ON RESECTABILITY ANDDOWNSTAGING

To assess the effect of neoadjuvant platinum-based chemotherapy on res ectability, stage of disease at resection, and patterns of recurrence and survival in patients with IIIA, N2 non-small-cell lung cancer, we examined the first 60 patients treated with neoadjuvant chemotherapy f ollowed by attempted resection in our institution. Of 67 patients iden tified, 7 patients were ineligible because of comorbidities, 3 patient s refused chemotherapy, and 1 consented but died before treatment. Fif ty-six received neoadjuvant chemotherapy. Complications of chemotherap y were minor, with no deaths. Fifty-four patients had thoracotomy; 75% (n = 42) had complete resection and 25% (n = 14) had unresectable les ions. One postoperative death occurred (2%). Pathologic review of spec imens and nodal groups revealed that 41% (n = 23) were downstaged, 39% (n = 22) remained stage IIIA, and 19% (n = 11) progressed. Squamous h istologic type was predictive of resectability, 18 of 20 patients havi ng resectable squamous cell tumors (p < 0.05). Actuarial survivals at 1 and 2 years were 74% and 52%, respectively. In patients with resecta ble tumors survivals at 1 and 2 years were 85% and 67%, respectively. For those with unresectable lesions, survivals were 43% and 14%. Relap se-free survivals at 1 and 2 years for patients with resectable lesion s were 70% and 42%, respectively. Relapses were local in 25% (n = 4), at a distant site only in 50% (n = 8), combined local and distant in 2 5% (n = 4). Distant relapse occurred in the central nervous system onl y in 7 of 8 patients (88%). Complete resectability was highly predicti ve of improved survival (p < 0.0002). Weight loss did not affect resec tability but was associated with decreased survival (p < 0.003). Neoad juvant chemotherapy appears to improve resectability and to pathologic ally downstage N2 non-small-cell lung cancer from stage IIIA. Multiins titutional randomized trials are needed to further demonstrate the eff icacy of this approach.