Induction chemoradiation and surgical resection for non-small cell lung carcinomas of the superior sulcus: Initial results of Southwest Oncology Group Trial 9416 (intergroup trial 0160)

Objective: The rate of complete resection (50%) and the 5-year survival (30 %) for non-small cell lung carcinomas of the superior sulcus have not chang ed for 40 years. Recently, combined modality therapy has improved outcome i n other subsets of locally advanced non-small cell lung carcinoma. This tri al tested the feasibility of induction chemoradiation and surgical resectio n in non-small cell lung carcinoma of the superior sulcus with the ultimate aim of improving resectability and survival. Methods: Patients with mediastinoscopy-negative T3-4 N0-1 superior sulcus r esponding disease underwent thoracotomy 3 to 5 weeks later. All patients re ceived 2 more cycles of chemotherapy and were followed up by serial radiogr aphs and scans. Survival was calculated by the Kaplan-Meier method and prog nostic factors were assessed for significance by Cox regression analysis. Results: From April 1995 to September 1999, 111 eligible patients (77 men, 34 women) were entered in the study, including 80 (72.1%) with T3 and 31 wi th T4 tumors. Induction therapy was completed as planned in 102 (92%) patie nts. There were 3 treatment-related deaths (2.7%). Cytopenia was the main g rade 3 to 4 toxicity. Of 95 patients eligible for surgery, 83 underwent tho racotomy, 2 (2.4%) died postoperatively, and 76 (92%) had a complete resect ion. Fifty-four (65%) thoracotomy specimens showed either a pathologic comp lete response or minimal microscopic disease. The 2-year survival was 55% f or all eligible patients and 70% for patients who had a complete resection. To date, survival is not significantly influenced by patient sex, T status , or pathologic response. Conclusions: (1) This combined modality treatment is feasible in a multiins titutional setting; (2) the pathologic complete response rates were high; a nd (3) resectability and overall survival were improved compared with histo rical experience, especially for T4 tumors, which usually have a grim progn osis.