Radiotherapy and concurrent continuous infusion of cisplatin with adjuvantsurgery in nonresectable Stage III lung carcinoma: Short- and long-term results of a Phase II study

Purpose: Cisplatin-enhanced radiotherapy plus adjuvant surgery was evaluate d in nonresectable non-small cell lung carcinoma (NSCLC) Methods and Materials: Doses of 50 Gy (administered in standard fractionati on in 5 weeks) were delivered with concurrent cisplatin in continuous infus ion (daily dose: 4 mg/m(2)), to 32 Stage IIIa and 45 Stage IIIb patients en rolled in a Phase II study. Patients without progression underwent surgery. Results: Esophagitis (64%), nausea/vomiting (34%), and pulmonary toxicity ( 14%) were the main side effects. Grade 3 toxicity occurred in 4 instances. A clinical locoregional major response was achieved by 55 patients (there w ere 10 complete responses). Forty patients underwent surgery, 7 with a nonr adical procedure. Seven patients died due to surgery-related complications, which were significantly impacted by right pneumonectomy (71% vs. 6% of th e other procedures,p < 0.0001). Eighteen of the 40 surgical patients were a ssessed to be without viable tumor and 11 with microresidual carcinoma. The re were 13 disease-free, 5-year survivors. Conclusions: Toxicity was low but activity high with the chemoradiotherapy, Adjuvant surgery increased the rate of complete responses, but right pneum onectomy had an unacceptable mortality. The role of surgery needs further r efinement. Integration of the chemoradiotherapy schedule with cisplatin-bas ed induction chemotherapy is advisable, (C) 1999 Elsevier Science Inc.