PREOPERATIVE CONCURRENT RADIATION-THERAPY AND CISPLATINUM CONTINUOUS-INFUSION IN IIIA (N2) NONSMALL CELL LUNG-CANCER - A PILOT-STUDY

From April 1991 to September 1993, 18 patients affected by a presumed operable IIIa (N2) non small cell lung cancer (NSCLC) with histologica lly confirmed bulky mediastinal metastases, received preoperative conc urrent radiation therapy and continuous infusion of cisplatinum (CDDP) . The radiotherapy consisted of 2 Gy given 5 days a week for a total d ose of 50 Gy; CDDP was administered by means of a central catheter and a portable pump at the daily dose of 6 mg/m2 given on the same days a s the radiation therapy (total dose: 150 mg/m2). Two weeks after the e nd of the treatment, the patients were reevaluated: 5 patients had eit her local or distant disease progression, the other 13 were submitted to thoracotomy: 12 received a complete resection and 1 patient underwe nt only a mediastinal lymphadenectomy, because pneumonectomy was impos sible due to lack of respiratory function. No histological evidence of cancer cells was observed in the specimens of 6 patients (33%). Radio logical response rate was 61% (11/18); resection rate was 66% (12/18) and complete resection rate was 61% (11/18). There was one postoperati ve death (5%). The 3 year actuarial survival rate is 63,6% for the pat ients who received a resection with a median survival time of 18 month s. All non operated patients died within one year. Combined preoperati ve treatment was well tolerated. Better results were achieved in patie nts with squamous cell carcinoma who had a complete resection followin g a total tumor sterilization with radio-chemotherapy.