Mature results from a phase II trial of accelerated induction chemoradiotherapy and surgery for poor prognosis stage III non-small-cell lung cancer

Mature results are reported from a phase II trial of accelerated induction chemoradiotherapy and surgical resection for stage III non-small-cell lung cancer whose prognosis is poor. Surgically staged patients with poor prognosis non-small-cell lungs cancer were eligible for this study. Four-day continuous intravenous infusions of cisplatin 20 mg/m(2)/ day, 5-fluorouracil 1,000 mg/m(2)/day, and etoposide 75 mg/m(2)/ day were given concurrently with accelerated fractionation radi ation therapy, 1.5 Gy twice a day, to a total dose of 27 Gy. Surgical resec tion followed in 4 weeks. Identical postoperative chemotherapy and concurre nt radiation to a total dose of 40 to 63 Gy was subsequently given. Between February 1991 and June 1994, 42 eligible and evaluable patients, 23 with stage IIIA disease and 19 with stage IIIB disease, were entered in th is trial. Treatment was well tolerated. The pathologic response rate was 40 %. This response was complete in 5%. With a median follow-up of 54 months, the Kaplan-Meier 4-year survival estimate is 19%: 26% for stage IIIA and 11 % for stage IIIB patients. Patients with apathological response, resectable disease, or a pathological downstaging to stage 0, I, or II had a better s urvival. The 4-year estimates of locoregional and distant disease control a re 70% and 19%, respectively. It is concluded that although the ultimate ro le of concurrent chemoradiotherapy and surgery in stage III non-small-cell lung cancer must await the results of phase III clinical trials, survival a nd locoregional control in this study appear improved in comparison with hi storical experience. There is a subset of patients, able to undergo resecti on with pathologic downstaging, who have a projected survival equivalent to that of patients with more limited disease. Clinical or pathologic tools t o identify these patients before treatment would be highly useful.