Ad. Elias et al., NEOADJUVANT TREATMENT OF STAGE IIIA NONSMALL CELL LUNG-CANCER - LONG-TERM RESULTS, American journal of clinical oncology, 17(1), 1994, pp. 26-36
The multimodality approach to locally advanced Stage III non-small cel
l lung cancer is continuing to evolve. In this trial, 54 patients with
surgically staged IIIA disease were treated with neoadjuvant chemothe
rapy, surgical resection, and chest radiotherapy. Response to four cyc
les of CAP chemotherapy (cyclophosphamide, doxorubicin. cisplatin) was
39% (8% complete responses). One septic death occurred. Thoracotomy w
as performed on 31 patients, of whom 29 (56%) were resected and 24 (44
%) were completely resected. Complete resections were more frequently
observed in chemotherapy responders. Extranodal mediastinal extension
in nonresponding patients was the most frequent reason not to attempt
thoracotomy. The overall median times to progression and survival were
11.6 (.7-66.5) and 17.9 (2.8-71.4) months. Long-term disease-free sur
vival was observed in 11 patients (20%) with a median follow-up of 46.
5 (24-71) months. All these patients underwent complete resection and
constitute 46% of the patients undergoing complete resection. Median t
imes to progression and survival were 33.4 (5.0-66.5) and 33.5 (10-71.
4) months for completely resected patients. Although the ability to pe
rform surgery identified a population that has favorable locoregional
control and disease-free survival, distant relapse continues to repres
ent the major obstacle to enhanced survival in resected patients. Unre
sected patients, however, are likely to relapse in both local and dist
ant sites. Response to chemotherapy may not only enhance systemic cont
rol, but may also increase the probability of complete resection. Rand
omized trials should be conducted to evaluate the role of individual m
odalities (surgery, chemotherapy, or radiotherapy) while applying the
remaining modalities maximally. The temptation to compare different tr
eatment approaches should be resisted.