Twelve-year follow-up of trimodality therapy for stage IIIA non-small celllung cancer

Non-small cell carcinoma of the lung (NSCLC) remains a formidable problem w ith a poor 5 year survival for stage III patients. Between 1985-1991, 53 pa tients with biopsy proven Stage IIIA NSCLC were treated with a trimodality treatment program. Chemotherapy, consisting of two cycles of continuous inf usion cisplatinum and bolus etoposide, was started on days 1 and 28 of radi ation therapy (54 Gy + 5.4 Gy boost in 6 1/2 weeks) directed to the lung pr imary and mediastinum. Four to six weeks after radiation therapy, patients underwent thoracotomy for radical pulmonary resection. Three weeks post sur gery, the same chemotherapy was repeated for two cycles every 28 days. Fort y-seven out of 53 patients (89%) achieved a clinical response after inducti on chemoradiation. Of these 47 patients, 33 underwent thoracotomy and 27 of them completed surgical resection. Treatment was well-tolerated. All survi ving patients have no or minimal respiratory toxicities. With a median foll ow up of 9 1/2 years, surgically treated patients have a disease specific s urvival of 42% at 12 years. One patient survived beyond 9 years without sur gery. Concurrent chemoradiation plus surgery is well tolerated and offers p atients with Stage IIIA NSCLC significant long term survival benefit and wa rrants further assessment in a randomized trial.