Neoadjuvant chemoradiotherapy of stage III non-small-cell lung cancer

Twenty to 30% of patients with non-small-cell lung cancer (NSCLC) in stage III are not resectable primarily with 5-year survival less than 10%. Since the majority of patients die from metastases, efforts have been made in the past to improve prognosis by application of neoadjuvant chemoradiotherapy regimens followed by subsequent resection. In a phase II study performed be tween 1993 and 1998, 93 patients in stage III (IIIA, 16%; IIIB, 84%) receiv ed an induction chemotherapy consisting of two cycles cisplatin (100 mg/m(2 )) and vindesine (3 mg/m(2)) with subsequent sequential radiotherapy of 36 Gy. Sixty-five patients demonstrated partial or complete remission. Sixty u nderwent surgery; in 49 of them complete resection was possible. Five-year survival in the whole group was 24%, and that in the surgical cohort 39%. S ix patients had no residual tumor. Postoperative NIO status was associated with a 5-year survival of 75%, and stage N1-3 with 13%. Thirty-day mortalit y was 7% postoperatively. Neoadjuvant chemoradiotherapy can significantly i mprove long-term survival in stage III NSCLC with an acceptable therapy-ind uced mortality. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.