High dose radiation therapy and chemotherapy as induction treatment for stage III nonsmall cell long carcinoma

BACKGROUND. The current study was conducted to review the authors' experien ce in treating consecutive patients with American Joint Committee on Cancer (1997 revision) Stage III nonsmall cell lung carcinoma with aggressive pre operative chemoradiation followed by surgical resection. METHOD. The records of all patients who received preoperative chemoradiatio n were evaluated. Patients received 2 cycles of concurrent cisplatin and et oposide with 5940 centigrays of radiation therapy. They then were reevaluat ed to determine whether they were surgical candidates. If so, resection of the primary tumor with mediastinal lymph node dissection was performed 4-6 weeks after the completion of preoperative treatment. After adequate healin g, an additional four cycles of cisplatin/etoposide or carboplatin/paclitax el was given. RESULTS. Forty-two patients received preoperative chemoradiation, 33 of who m underwent surgical resection (79%), including 9 patients who underwent pn eumonectomies. Complete pathologic responses were observed in 27% of these patients. Postoperative complications were noted in 21% of the patients and included persistent air leak, supraventricular arrhythmia, and empyema. Th ere were no reported treatment-related deaths. The median follow-up was 26 months. The overall 5-year survival rate for ail patients was 36.5% and was 45.3% for patients who underwent resection. A trend toward increased 5-yea r survival was observed in patients who had a complete pathologic response (57.1%). Univariate analysis revealed the N stage classification to be sign ificant for predicting a complete response. Patterns of failure revealed th e brain to be the most common site of first recurrence (50%) and the only s ite of recurrence in 36% of patients. There was only one case of local fail ure. CONCLUSIONS. Preoperative chemoradiation using high radiation doses is feas ible with acceptable toxicity. The results of the current study suggest an increased complete pathologic response rate and increased overall survival rate compared with reports in the published literature. (C) 2000 American C ancer Society.