Short-course induction chemoradiotherapy with paclitaxel for stage III non-small-cell lung cancer

Background. This study assessed toxicity, tumor response, disease control, and survival after short-course induction chemoradiotherapy and surgical re section in patients with stage III non-small-cell lung carcinoma. Methods. Forty-five patients with stage III non-small-cell lung carcinoma r eceived 12-day induction therapy of a 96-hour continuous infusion of cispla tin (20 mg/m(2) per day), 24-hour infusion of paclitaxel (175 mg/m(2)), and concurrent accelerated fractionation radiation therapy (1.5 Gy twice daily ) to a dose of 30 Gy. Surgical resection was scheduled for 4 weeks later. P ostoperatively, a second identical course of chemotherapy and concurrent ra diation therapy (30 to 33 Gy) was given. Results. Induction toxicity resulted in hospitalization of 18 (40%) patient s for neutropenic fever. No induction deaths occurred. Of 40 (89%) patients who underwent thoracotomy, resection for cure was possible in 32 (71%) pat ients. Pathologic response was noted in 21 (47%) patients, and 14 (31%) wer e downstaged to mediastinal node negative (stage 0, I, or II). At a median follow-up of 19 months, 24 patients were alive, 10 with recurrent disease. Of 21 deaths, 16 were from recurrent disease, three were from treatment, an d two were unrelated. Recurrent disease was distant in 21 patients, distant and locoregional in 2, and locoregional in 3. The Kaplan-Meier projected 2 4-month survival is 49%. Projected 24-month survival is 61% for stage IIIA, 17% for stage IIIB (p = 0.035); 84% for pathologic responders, 22% for non responders (p < 0.001); 83% for downstaged patients (stage 0, I, or II), 33 % for those not downstaged (p = 0.005); and 63% for resectable patients, 14 % for unresectable patients (p = 0.007). Conclusions. We conclude that short-course neoadjuvant therapy with paclita xel (1) has manageable toxicity and a low treatment mortality, (2) results in good tumor response and downstaging, (3) provides excellent locoregional control with most recurrences being distant, and (4) has improved the medi an survival compared with historical controls. Survival was better in stage IIIA patients, resectable patients, pathologic responders, and patients do wnstaged to mediastinal node negative disease (stage 0, I, or II). (C) 1998 by The Society of Thoracic Surgeons.