NEOADJUVANT THERAPY - A NOVEL AND EFFECTIVE TREATMENT FOR STAGE IIIB NONSMALL CELL LUNG-CANCER

Neoadjuvant therapy has become an accepted treatment for stage IIIa, b ut not for stage IIIb, non-small cell lung cancer, which is usually co nsidered incurable and treated nonsurgically. We determined the feasib ility of neoadjuvant therapy in the setting of stage IIIb, non-small c ell lung cancer in a prospective multiinstitutional trial. For patient s to be eligible for entry into the study, they had to have pathologic ally documented T1-4 N2-3 disease. Treatment consisted of: (1) cisplat in (50 mg/m(2)) given on days 1, 8, 29, and 36 plus VP-16 (50 mg/m(2)) given on days 1 to 5 and 29 to 33, together with concurrent radiother apy (4,500 cGy; 180 cGy per daily fraction); and (2) surgical resectio n performed 3 to 5 weeks after induction of medical therapy, if the re sponse was stable, partial, or complete. Of the 126 total eligible pat ients entered into the study, 51 patients had stage IIIb tumors (24 wi th T4 tumors and 27 with N3 disease). This consisted of 34 men and 17 women with a median age of 57 years. Thirty-two (63%) patients (18 wit h T4 tumors and 14 with N3 disease) underwent resection of the primary tumor, with a 5.2% operative mortality. There was no difference in th e operative time, blood loss, and length of hospital stay for the T4 v ersus the N3 patients. For all 51 patients, survival at 2 years was 39 %. Sites of relapse in all patients were mainly distant, even though p atients with N3 disease did not initially have involved N3 nodes resec ted. Our experience shows the feasibility of instituting neoadjuvant t herapy in patients with stage IIIb non-small cell lung cancer, and sug gests that such patients could be included in future trials designed t o evaluate the role of surgical resection in the combined-modality tre atment of stage III non-small cell lung cancer.