Benefit of surgery after chemoradiotherapy in stage IIIB (T4 and/or N3) non-small cell lung cancer

Objective: The purpose of this study was to evaluate postchemoradiotherapy surgery in stage IIIB non-small cell lung cancer. Methods: Forty patients with stage IIIB non-small cell lung cancer were inc luded in this phase II study. A preoperative diagnosis of stage IIIB cancer was based oil mediastinoscopy or a thoracotomy in all patients. Induction treatment included two cycles of cisplatin (100 mg/m(2), day 1), 5-fluorour acil (1 g/m(2), days 1-3), and vinblastine (4 mg/m2, day 1) combined with 4 2 Gy of hyperfractionated radiotherapy delivering 21 Gy in two sessions. Pa tients with a clinical response were offered surgery. Results: The minimum follow-up for survivors was 48 months. Thirty patients had a T4 lesion and 18 had N3 disease. Twenty-nine patients (73%) had a cl inical objective tumor response after induction treatment. These 29 patient s underwent thoracotomy, and a complete resection was performed in 23 (58%) . Two postoperative deaths occurred (7%). Four patients had a pathologic co mplete response at the time of surgery (10%). The 5-year survival is 19% fo r the overall population. When only patients who had persistent viable tumo r cells at surgery are considered (n = 25), the 5-year survival is 28%. The 5-year survival is 42% for patients having no mediastinal lymph node invol vement at the time of surgery and being treated with complete resection. Conclusion: This study shows that surgery, when feasible, is associated wit h a 28% long-term survival for patients in whom chemoradiotherapy alone fai ls to control disease.